{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:27:26Z","timestamp":1790695646590,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multi\u2010centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant\u2010survival were analysed using Kaplan\u2013Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 61 HLAi and 122 HLAc recipients; mean age 46\u2009years; 60% female. MFI<jats:sub>T0<\/jats:sub>: 3327 (IQR 1352\u20136458), 23 (38%) were Flow cytometry crossmatch positive (FC\u2010XM<jats:sub>POS<\/jats:sub>). DSA<jats:sub>POS<\/jats:sub>\/FC\u2010XM<jats:sub>POS<\/jats:sub> transplantation carried an increased risk of AMR at 1\u00a0year (52%) compared to DSA<jats:sub>POS<\/jats:sub>\/FC\u2010XM<jats:sub>NEG<\/jats:sub> (27%) and HLAc (0%). Unadjusted death censored graft loss at 3\u2009years was 13% (HLAi) and 8% (HLAc). Three\u2010year patient survival was 95% in HLAc, 84% in DSA<jats:sub>POS<\/jats:sub>\/FC\u2010XM<jats:sub>NEG<\/jats:sub> and 69% in DSA<jats:sub>POS<\/jats:sub>\/FC\u2010XM<jats:sub>POS<\/jats:sub> recipients; 58% of HLAi deaths were infection\u2010related. HLA incompatibility was associated with a decreased 3\u2010year survival in our PS\u2010matched cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In kidney transplantation, DSA and positive FC\u2010XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitized patients facing prolonged waiting times and reduced survival on dialysis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nep.14102","type":"journal-article","created":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T05:38:35Z","timestamp":1661578715000},"page":"962-972","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: A national cohort study"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2609-5485","authenticated-orcid":false,"given":"Trijntje J. 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