Temporal Changes in the Impact of HLA Mismatching Among Pediatric Kidney Transplant Recipients

Background Allocation for pediatric deceased-donor kidney transplantation (pDDKT) in the United States now deemphasizes HLA matching to improve equality in access to transplantation, but other national systems still consider HLA matching due to concerns about graft survival. We hypothesized that the impact of HLA mismatching has decreased over time due to advances including improved immunosuppression. Methods Using SRTR data, we analyzed whether the association between the number of HLA mismatches and outcomes of first-time pDDKTs changed between 2 eras: 1995-2004 (N=2854) and 2005-2014 (N=4643). Results Between eras, the median number of mismatches increased from 4 to 5 (p

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