ArticleKidney international reports2026
Recipient Human Leukocyte Antigen-DR Homozygosity and Access to Quality Kidneys.
Article in Kidney international reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
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Abstract
Introduction: A primary objective of transplantation is equitable access to quality deceased donor kidney transplantation (DDKT), which includes highly-matched human leukocyte antigen (HLA)-DR DDKT. Little research has been conducted on DDKT access among HLA-DR homozygous candidates, who have 2 serologically equivalent HLA-DR alleles and have low frequency in general populations. Our aim was to investigate DDKT access by HLA-DR mismatches across HLA-DR homozygosity and race/ethnicity. Methods: Our Scientific Registry of Transplant Recipients (SRTR) sample included 262,815 adult, primary, kidney-only transplant candidates from January 1, 2015 to May 31, 2024. We used 2021 Organ Procurement and Transplantation Network (OPTN) equivalency tables to identify serologically equivalent HLA-DR antigens for defining HLA-DR homozygosity and mismatches. We conducted Fine and Gray's competing risk analysis to estimate subdistribution hazard ratios (sHRs) for receiving all DDKT and DDKT with 0, 1, and 2 HLA-DR mismatches by HLA-DR homozygosity alone and interacted with race/ethnicity. Results: HLA-DR homozygosity was associated with a 0.95 sHR (95% confidence interval [CI]: 0.93-0.97) of receiving all DDKT, 0.46 sHR (95% CI: 0.43-0.49) of receiving DDKT with 0 HLA-DR mismatches, 0.83 sHR (95% CI: 0.81-0.86) of receiving DDKT with 1 HLA-DR mismatches, and conversely, 1.40 sHR (95% CI: 1.36-1.44) of receiving DDKT with 2 HLA-DR mismatches. Models interacting HLA-DR homozygosity and race/ethnicity showed that HLA-DR homozygosity was associated with a lower likelihood of receiving DDKT with 0 HLA-DR mismatches for all races/ethnicities. Conclusion: HLA-DR homozygosity was associated with lower access to DDKT, particularly highly-matched DDKT, irrespective of race/ethnicity. Prioritization for access to transplantation should incorporate HLA-DR homozygosity to promote equity.
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