USA Pancreas Graft Outcome by Human Leukocyte Antigen (HLA) Matching

For 1-year TS 1996-2002 US cadaver primary pancreas transplants, there was almost no HLA matching effect at the A and/or B loci in SPK, some effect in PAK and significant effect in PTA. The 1-year GSRs in PTA and PAK cases were highest with 0 or 1 mm. At 2-years, the differences were yet more apparent: For 0,1, 2, 3,and 4 mm, 2-year GSRs for PAK were 76%, 72%, 68%, 71% and 63% respectively and for PTA were 89%, 75%, 71%, 65% and 57% respectively (Wilcoxon p=0.3; Log Rank p=0.04). The proportion of good HLA matches for PTA was higher compared to PAK and SPK. The mean number of mismatches (mm) in PTA for 1999-2002 was 3+1.5, significant compared to 4.5+1.4 for SPK and 4.1+1.4 for PAK, disregarding shared PAK mm (p<0.0001). Shared mm occur with PAK where some pancreas mm may be identical to those with the kidney donor that may have been proven to be acceptable. PAK GSRs analyzed strictly by HLA mm are more difficult to interpret because some mm may be against the previous kidney donor, while the recipient's response may be inert. The lowest SPK GSR was for 0 mm; this may be due to greater use of multiple-risk donors in order to treat uremia (see preservation time discussion above). The trend to place less emphasis on matching continues for SPK: 4 mm (out of a possible 6) in 1987-95 and approximately 5 mm in 1999-2002.