{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:54:52Z","timestamp":1781124892334,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The UK Kidney Allocation Scheme (KAS) prioritizes organ allocation based on HLA mismatches, assigning the greatest weight to HLA\u2010DR compatibility. However, the clinical relevance of this approach across different ethnicities in the era of modern immunosuppression remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective cohort study of 25\u00a0094 adult deceased donor kidney transplants in the United Kingdom between 2008 and 2020. Using competing risk Cox regression, we evaluated the impact of individual HLA locus mismatches and grouped mismatch levels (as defined by UK\u2010KAS) on graft survival. Subgroup analyses by ethnicity were performed, and the relationship between HLA mismatches and acute rejection was assessed using logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A single HLA\u2010DR mismatch was significantly associated with graft failure (SHR 1.119, 95% CI 1.035\u20131.211,\n p<\/jats:italic>\n \u00a0=\u00a00.005), while mismatches at the A, B, and DQ loci were not. In subgroup analyses, HLA\u2010DR mismatching was predictive of graft failure in Asian recipients but not in Black recipients. Black patients also exhibited higher rates of mismatching at all loci. DQ mismatches were associated with early acute rejection but did not predict long\u2010term graft failure. Ten\u2010year graft survival was 13% less with one HLA DR mismatch, and 17% less with 2 HLA DR mismatch, in comparison to zero DR mismatch. The four\u2010level HLA mismatch grouping used by UK\u2010KAS stratified risk incrementally, with levels 3 and 4 associated with 13% and 19% higher failure risk, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n HLA\u2010DR matching improves graft survival overall but offers limited benefit in Black recipients, likely due to low\u2010resolution typing inadequately capturing immunological compatibility across ethnic lines. The current UK\u2010KAS scoring system may inadvertently disadvantage ethnic minorities by delaying transplantation for matches that confer minimal benefit. Our findings support incorporating ethnicity\u2010specific considerations into kidney allocation policy to promote equity and optimize outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ctr.70429","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T11:31:02Z","timestamp":1767699062000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["HLA\u2010DR Matching in Kidney Transplantation: Ethnic Disparities in Clinical Benefit and Policy Implications From a UK Registry Analysis"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3141-7015","authenticated-orcid":false,"given":"Hatem","family":"Ali","sequence":"first","affiliation":[{"name":"Renal Department University Hospitals of Wales, Cardiff and Vale University Health Board Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Briggs","sequence":"additional","affiliation":[{"name":"NHS Blood and Transplant Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithya","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Renal Department University Hospitals of Coventry and Warwickshire Coventry UK"},{"name":"The Centre of Healthcare and Communities Coventry University Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfu216"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067411"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2481"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.10860917"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg1028"},{"key":"e_1_2_9_7_1","first-page":"1581","article-title":"Influence of HLA Compatibility on Graft Survival in Kidney Transplantation","volume":"12","author":"Opelz G.","year":"2012","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03606.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16070"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067411"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1911281116"},{"issue":"6","key":"e_1_2_9_12_1","first-page":"800","article-title":"Variable Selection\u2014A Review and Recommendations for the Practicing Statistician","volume":"62","author":"Heinze G.","year":"2020","journal-title":"Biometrical Journal"},{"key":"e_1_2_9_13_1","volume-title":"Stata 17 Lasso Reference Manual","author":"StataCorp","year":"2021"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.832488"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7111.1394"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010018\u20100908\u20103"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2481"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.10860917"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11641115"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.06.026"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70429","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70429","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70429","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:09:25Z","timestamp":1776251365000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ctr.70429"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70429","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70429"}}