Researchers have reported a survival benefit for people who received kidney transplants from HLA-incompatible live donors compared with either those remaining on the kidney transplant waiting list or those who received kidney transplants from immune system-compatible deceased donors. Human leukocyte antigen (HLA) is a protein on the surfaces of human cells that identifies the cells as “self” or “foreign,” and performs essential roles in immune responses. There are multiple forms of HLAs, which vary among individuals and are analyzed in laboratory tests to determine whether one person’s organs and tissues are compatible with another person’s, and could be used in a transplant. The more closely the HLAs match between a donor and recipient, the less likely a transplant will be rejected by the recipient’s immune system. To overcome HLA-incompatible transplants, organ transplant recipients undergo “desensitization” protocols to remove antibodies in the blood that can harm the donated organ. Previous research from a single center indicated a survival benefit with kidney transplants from HLA-incompatible live donors as compared with those waiting for a compatible organ.
To assess whether the survival benefit seen in the single center study is generalizable on a national scale, a 22-center study was designed and conducted. The researchers assessed the survival of people who received kidney transplants from HLA-incompatible live donors, at multiple time points up to 8 years after transplantation. They compared these outcomes with the survival of two control groups—those who remained on the waiting list or received a transplant from a deceased donor, and those who remained on the waiting list but did not receive a transplant. The multicenter study reported that a kidney transplant from an HLA-incompatible live donor was associated with a significant survival benefit compared to the two control groups. As a compatible live kidney donor is rarely available, these results suggest that the patient now could consider the option to undergo incompatible transplantation.