ORIGINAL RESEARCH
Transpl. Int.
Living Donation and Pre-Emptive Transplantation Are More Important Than HLA Matching in Pediatric Kidney Transplantation: Results From a 33-Year Comparative OPTN Study
- AP
Alicia Paessler 1
- ID
Ioannis D Kostakis 2
- IL
Ioannis Loukopoulos 1,3,4
- ZA
Zainab Arslan 1,5
- NK
Nicos Kessaris 1,3,4
- JS
Jelena Stojanovic 1,5
1. Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
2. Royal Free London NHS Foundation Trust, London, United Kingdom
3. Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
4. Evelina London Children's Hospital, London, United Kingdom
5. University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Abstract
Poorly HLA matched transplants have poorer long-term outcomes, however it is unclear whether living donation or pre-emptive transplantation can counteract the effects of HLA mismatches. We reviewed the long-term outcomes of paediatric kidney transplants with different HLA matches and aimed to identify other factors which may contribute significantly to long-term outcomes. We conducted a retrospective registry analysis of all pediatric kidney transplants from 1987-2020 in the USA from the OPTN Registry. These were analysed by HLA mismatches and compared by pre-transplant dialysis status and donor type. 21,500 patients were included for analysis. Overall, patients with unfavourable HLA matches had higher rates of delayed allograft function and lower allograft survival. However, patients with unfavourable HLA matched transplants from living donors had better allograft survival than patients with favourable HLA matched transplants from deceased donors (79% at 5 years vs 71%, p<001). Patients with pre-emptive unfavourable HLA matched transplants had better allograft and patient survival than patients with non-pre-emptive favourable HLA matched transplants (83% at 5 years vs 78%, p=002 and 98% vs 96%, p<001 respectively). In conclusion, living donation and pre-emptive transplantation have a more significant impact on clinical outcomes and lead to better allograft and patient survival than HLA matching.
Summary
Keywords
pediatric, Kidney transplant, HLA Mismatch, registry, Survival analysis
Received
09 June 2025
Accepted
23 October 2025
Copyright
© 2025 Paessler, Kostakis, Loukopoulos, Arslan, Kessaris and Stojanovic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alicia Paessler, alicia.paessler@nhs.net
Disclaimer
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