Abstract: TH-PO0903
Trends in Human Leukocyte Antigen (HLA) Mismatches Among Kidney Transplant Recipients in the United States (US)
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Puttarajappa, Chethan M., University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
- Morford, Harry, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
- Tambur, Anat R., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Background
Better HLA matching improves allograft survival and will allow for reduced immunosuppression. Over the past decades, priority for HLA matching in deceased donor kidney transplantation (DDKT) has changed significantly in the US. Additionally, the proportion of unrelated living donors has increased, The impact of these changes on HLA mismatches is unknown..
Methods
Using Scientific Registry of Transplant Recipients data (N=525,467), we examined the prevalence of zero HLA-ABDR and zero HLA-DR mismatches among living and deceased donor KT, including among racial subgroups.
Results
Table 1 shows characteristics of study cohort. In both DDKT and LDKT, the prevalence of zero ABDR and zero DR mismatches has decreased significantly over the past 3 decades, with only ~5% and ~15% of recent cohorts having zero ABDR and DR mismatches respectively. (Figure 1). This decreasing prevalence over time was noted among all races.
Conclusion
There has been a marked decline in HLA matching among kidney recipients in the US. While competing priorities influence organ allocation, efforts to optimize HLA matching should still be considered—particularly for patients more likely to require a repeat transplant. Also, the use of paired kidney donation for HLA matching needs further exploration.
Demographics
| Characteristic | N=525,467 |
| Age, yr (SD) | 48 (16) |
| Female | 208,511 (40%) |
| White | 353,183 (67%) |
| Black | 134,193 (26%) |
| Living donor | 175,969 (33%) |
| Biologically related LD | 101,084 (60%) |
| Pediatric | 46,201 (8%) |
| Zero ABDR mismatch | 46,314 (9%) |
| Zero DR mismatch | 115,624 (23%) |
Funding
- NIDDK Support