A New HLA Allocation Procedure of Kidneys From Deceased Donors in the Current Era of Immunosuppression

Abstract Introduction It has recently been proposed to replace the current Eurotransplant kidney allocation based primarily on mismatches (MM) at the 3 HLA loci by a simpler system based on full HLA-DR compatibility. The present study analyzes this system in the current era of immunosuppression. Methods From 1999 to 2012, 723 renal grafts were performed on 586 patients who were treated with a calcineurin inhibitor, mycophenolate mofetil, and in most cases antilymphocyte globulins. Four groups of HLA MM were compared: (A) A+B 2-4/DR 1-2 MM (n = 397), (B) A+B 2-4 MM/DR 0 MM (n = 106), (C) A+B 0-1 MM/DR 1-2 MM (n = 138), and (D) A+B 0-1/DR 0 MM (n = 82). Results Acute rejection episodes were less frequent during the first post-transplantation year in group D than in the other groups ( P  = .018). Patient survival was lower in group A than in the other groups ( P  = .008). Immunologic graft survival was higher in group D than in the other groups in univariate ( P  = .015) and multivariate analyses ( P  = .033; 96.4% vs 90.1% at 10 years). Conclusions In the current era of immunosuppression, allocation of kidneys from deceased donors could be performed primarily according to full DR compatibility then to the best A+B matching, affording excellent graft outcome to most recipients.