The Impact of Kidney Donor Profile Index and Human Leukocyte Antigen Mismatch on Graft Survival in Pediatric…

Cohort studyPediatric transplantation· Jun 2026

The Impact of Kidney Donor Profile Index and Human Leukocyte Antigen Mismatch on Graft Survival in Pediatric Kidney Transplant Recipients.

Saritha Ranabothu, Jodi M Smith, James Perkins … Rachel M Engen

Pediatric NephrologyCohort studyPrognosisQ2IF 1.5

HLA mismatch of 3-6 predicts worse pediatric kidney graft survival than KDPI

The Impact of Kidney Donor Profile Index and Human Leukocyte Antigen Mismatch on Graft Survival in Pediatric Kidney Transplant Recipients.

Saritha Ranabothu … Rachel M Engen

Pediatric transplantation · Jun 2026 · Q2 in Pediatrics

Background

Pediatric kidney transplant recipients typically receive low-KDPI deceased donor kidneys but often experience higher HLA mismatches.

Methods

We conducted a retrospective review of SRTR data in evaluating the association between KDPI and HLA mismatch.

Results

3-6 HLA mismatches cut graft survival more than KDPI does

HR by subgroup · 95% CI

More results

There was no significant difference in death-censored graft survival between KDPI < 30% and ≥ 30% (HR 0.74; 95% CI: 0.51-1.08; p = 0.11).

In combined models, any group with HLA MM 3-6 had worse graft survival regardless of KDPI.

No significant differences were found in patient survival across groups.

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Conclusion · 1 of 2

HLA mismatch is a stronger predictor of graft outcomes than KDPI in pediatric kidney transplantation. The limited number of high-KDPI donors in pediatric recipients may explain the lack of significant association with KDPI.

Conclusion · 2 of 2

These findings support efforts to minimize HLA mismatches in pediatric allocation strategies.

The Impact of Kidney Donor Profile Index and Human Leukocyte Antigen Mismatch on Graft Survival in Pediatric Kidney Transplant Recipients.

The Impact of Kidney Donor Profile Index and Human Leukocyte Antigen Mismatch on Graft Survival in Pediatric Kidney Transplant Recipients.

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