No Differences in Outcomes of HLA-Incompatible Living Donor Transplantation versus Other Models

New Orleans—Due to the shortage of available kidneys for transplantation, human leukocyte antigen (HLA)-incompatible living donor kidney transplantation is utilized to increase opportunity for sensitized end-stage renal disease patients. There are inconsistencies in outcomes associated with HLA-incompatible kidney transplantation, however. Data in the United States demonstrated better outcomes for patients undergoing HLA-incompatible kidney transplantation compared with HLA-compatible deceased donor transplantation or dialysis. In the United Kingdom, data demonstrated that waiting for deceased donor kidney transplantation or HLA-compatible living donor transplantation had favorable outcomes compared with HLA-incompatible living donor transplantation.

Researchers in Korea, led by Tai yeon Koo, MD, sought to compare outcomes of HLA-incompatible living donor transplantation with those of deceased donor kidney transplantation or dialysis, and HLA-compatible living donor kidney transplantation in Korea. They reported results during a poster session at Kidney Week 2017 in a poster titled Outcomes of HLA-Incompatible Living Donor Kidney Transplantation Compared to Deceased Donor Kidney Transplantation or Dialysis and HLA-Compatible Living Donor Kidney Transplantation.

Between 2006 and 2017, 48 patients underwent HLA-incompatible living donor kidney transplantation after desensitization at Seoul National University Hospital, Seoul, Republic of Korea. The researchers compared outcomes among the 48 patients with those of wait-listed patients who continued to undergo dialysis (n=2047), those who underwent either dialysis or deceased donor kidney transplantation (n=2610), patients who underwent decreased donor transplantation (n=563), and patients who underwent HLA-compatible living donor transplantation (n=654).

In the group who underwent HLA-incompatible living donor transplant, patient survival rates were 97.8% at 1 year, 97.8% at 5 years, and 97.8% at 8 years; compared with rates of 98.4%, 96.4%, and 94.8%, respectively in the group undergoing dialysis; rates of 98.3%, 97.2%, and 95.2%, respectively, in the dialysis or deceased donor kidney transplantation group; rates of 99.7%, 99.4%, and 98.6%, respectively, in the HLA-compatible living donor kidney transplantation group. The differences in patient survival among the groups were not significant.

There was no significant difference in graft survival between the HLA-incompatible living donor transplantation group and any other group, although the graft survival rate at 6 months was worse in the HLA-incompatible living donor transplantation group compared with the HLA-compatible living donor transplantation group.

Both patient and graft survival rates were better in the HLA-compatible living donor transplantation group than in the dialysis or deceased donor transplantation group. There were no differences among the groups in incidence of either antibody-mediated rejection or infectious complications.

In conclusion, the researchers said, “Outcomes of HLA-incompatible living donor kidney transplantation were comparable with those of dialysis or deceased donor kidney transplantation, dialysis alone, and HLA-compatible living donor kidney transplantation. Therefore, we should consider many factors such as outcomes of dialysis, mean waiting time for HLA-compatible deceased donor kidney transplantation, donor exchange program, and experience of desensitization before [making a] decision of HLA-incompatible living donor kidney transplantation in sensitized candidates.”

Source: Koo Ty, Ryu J-h, Yan J-J, Min K, Yang J. Outcomes of HLA-incompatible living donor kidney transplantation compared to deceased donor kidney transplantation or dialysis and HLA-compatible living donor kidney transplantation. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 3, 2017, New Orleans, Louisiana.