These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: HLA-DR matching in organ allocation: balance between waiting time and rejection in pediatric kidney transplantation.
    Author: Vu LT, Baxter-Lowe LA, Garcia J, McEnhill M, Summers P, Hirose R, Lee M, Stock PG.
    Journal: Arch Surg; 2011 Jul; 146(7):824-9. PubMed ID: 21768429.
    Abstract:
    OBJECTIVES: To determine the impact of HLA-DR mismatching on rejection, graft survival, and sensitization in a local allocation system that emphasizes donor quality rather than HLA antigen matching for pediatric patients and to determine the likelihood of finding an appropriate donor based on HLA-DR mismatch. DESIGN: Retrospective cohort study. SETTING: A single institution. PATIENTS: A total of 178 patients younger than 21 years who underwent kidney transplantation with daclizumab induction between 1997 and 2006. MAIN OUTCOME MEASURES: The association between HLA-DR mismatching and rejection or graft survival was determined using survival analysis. Sensitization was defined as a posttransplantation panel reactive antibody level greater than 0% in patients with a pretransplantation level of 0%. RESULTS: Median follow-up was 4.1 years (interquartile range, 2.1-6.1 years). One- and 5-year graft survival rates were 97% and 82%, respectively. HLA-DRB1 mismatches were a significant risk factor for rejection; patients with 1- or 2-HLA-DRB1 mismatches had 1.7 times greater odds of rejection than those with 0-HLA-DR mismatches (P = .006). HLA-DRB1 mismatching was not a significant risk factor for either graft failure or sensitization, but history of rejection was an independent predictor of graft failure (hazard ratio, 7.7; P = .01) and sensitization (odds ratio, 9.7; P = .001). Although avoiding HLA-DRB1 mismatching reduces rejection, the probability of finding ABO-matched local donors younger than 35 years without DR mismatches was extremely low. CONCLUSION: Although avoiding HLA-DRB1 mismatching is beneficial, the likelihood of finding an HLA-DRB1-matched donor should also be considered in donor selection.
    [Abstract] [Full Text] [Related] [New Search]