Due to a widespread organ shortage, the use of expanded criteria donors (ECDs) in kidney transplantation has increased persistently, reaching approximately 40% in recent years. Whether human leucocyte antigen (HLA) matching between donor and recipient should be part of allocation algorithms in transplantation of ECD kidneys, and especially of ECD kidneys from ≥70-year-old donors, is still in question. To this end, 135,529 kidney transplantations performed between 2000 and 2017 and reported to the Collaborative Transplant Study were analysed and the impact of HLA-A+B+DR mismatches on death-censored graft and patient survival as well as on rejection episodes was investigated. Results were stratified according to donor status (standard criteria donor (SCD) versus ECD) and age of ECD. HLA incompatibility increased the five-year death-censored graft failure risk similarly strong in recipients of ECD and SCD transplants (hazard ratio (HR) per HLA mismatch 1.078 and 1.075, respectively; p < .001 for both). Its impact on rejection treatments during the first post-transplant year was also significant but slightly weaker for recipients of ECD transplants (risk ratio (RR) per HLA mismatch 1.10 for ECD transplants and 1.13 for SCD transplants; p < .001 for both). Mortality increased gradually from zero to six HLA mismatches in recipients of SCD transplants, whereas for ECD transplants a significant increase was notable only from zero to more than zero mismatches. A significant but slightly less pronounced impact of HLA incompatibility on graft failure was observed in transplants from ≥70- compared with <70-year-old ECDs (HR per mismatch 1.047 and 1.093; p = .009 and < 0.001, respectively). The influence of HLA mismatches on rejection treatments was the same for both ECD age groups (RR = 1.10, p < .001 and p = .004, respectively). Our data indicate that HLA matching should be part of allocation algorithms not only in transplantation of kidneys from SCDs but also from ECDs.

中文翻译：

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HLA 相容性对扩大标准捐献者肾脏受者的影响：协作移植研究报告

由于广泛的器官短缺，扩大标准供体（ECD）在肾移植中的使用持续增加，近年来达到约 40%。供者和受者之间的人类白细胞抗原 (HLA) 匹配是否应该成为 ECD 肾脏移植分配算法的一部分，尤其是来自 70 岁以上供者的 ECD 肾脏，仍然存在疑问。为此，对 2000 年至 2017 年间进行并报告给协作移植研究的 135,529 例肾移植进行了分析，并研究了 HLA-A+B+DR 错配对死亡删失的移植物和患者存活率以及排斥反应的影响。结果根据供体状态（标准供体 (SCD) 与 ECD）和 ECD 年龄进行分层。HLA 不相容性增加了 ECD 和 SCD 移植受者的 5 年死亡删失移植失败风险（每个 HLA 错配的风险比 (HR) 分别为 1.078 和 1.075；两者 p < .001）。它在移植后第一年对排斥治疗的影响也很显着，但对 ECD 移植受者而言略弱（ECD 移植每 HLA 错配的风险比 (RR) 为 1.10，SCD 移植为 1.13；两者 p < .001）。SCD 移植受者的死亡率从零逐渐增加到 6 个 HLA 不匹配，而对于 ECD 移植，显着增加仅从零到超过零不匹配。在≥70- 的移植中观察到 HLA 不相容性对移植失败的显着但稍显不明显的影响与 < 70 岁的 ECD（每个错配的 HR 为 1.047 和 1.093；分别为 p = .009 和 < 0.001）。HLA 不匹配对排斥治疗的影响对于两个 ECD 年龄组是相同的（RR = 1.10，p < .001 和 p = .004，分别）。我们的数据表明，HLA 匹配应该是分配算法的一部分，不仅在 SCD 的肾脏移植中，而且在 ECD 的肾脏移植中也是如此。