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Locus-specific HLA matching and induction therapy in simultaneous pancreas–kidney transplantation: a national UK cohort study

Lookup NU author(s): Abdullah Malik, Dr Sam Tingle, Professor Derek Manas, Professor Neil SheerinORCiD, Professor Colin Wilson, Steven White

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

Simultaneous pancreas-kidney (SPK) transplantation offers the best long-term survival for selected individuals with insulin-dependent diabetes mellitus and end-stage renal disease. However, long-term pancreas graft survival remains variable, and the role of HLA mismatch and induction therapy in SPK outcomes remains incompletely defined. We conducted a retrospective cohort study of 1705 SPK recipients transplanted in the UK between 1^st April 2007 and 31^st March 2019. Using national transplant registry data, we analysed the impact of locus-specific HLA mismatch and induction therapy (Alemtuzumab vs Basiliximab) on pancreas graft, kidney graft, and patient survival. Multivariable Cox proportional hazards models were adjusted for donor, recipient, and transplant variables. Pancreas graft survival at 1-, 5-, and 10-years post-transplant was estimated to be 88.6%, 81.3%, and 72.7%, respectively. Kidney graft and patient survival at 10 years were 76.7% and 75.3%. In adjusted analyses, donor age, cold ischaemic time, and HLA-DQ mismatch were significantly associated with pancreas graft loss. Notably, recipients with a single DQ mismatch had improved long-term pancreas graft survival compared to those with no mismatch (HR 0.75, 95% CI 0.59–0.94, p=0.033), a finding not observed for kidney or patient outcomes. No significant survival difference was seen between Alemtuzumab and Basiliximab induction therapy. Our findings suggest a possible protective effect of a single DQ mismatch, warranting further immunogenetic and mechanistic investigation. These data may inform future strategies for induction selection and organ allocation in SPK transplantation.

Publication metadata

Author(s): Malik AK, Banks J, Counter C, Simmonds L, Tingle SJ, Sinha S, Muthasamy A, Sutherland A, Casey J, Drage M, van Dellen D, Callaghan CJ, Elker D, Manas DM, Pettigrew GJ, Russell N, Sheerin NS, Wilson CH, White SA, NHSBT Pancreas Advisory Group

Publication type: Article

Publication status: Published

Journal: Transplant International

Year: 2026

Volume: 39

Print publication date: 09/09/2026

Online publication date: 09/09/2026

Acceptance date: 20/08/2026

Date deposited: 03/08/2026

ISSN (print): 0934-0874

ISSN (electronic): 1432-2277

Publisher: Frontiers Media SA

URL: https://doi.org/10.3389/ti.2026.16427

DOI: 10.3389/ti.2026.16427

Data Access Statement: The data analyzed in this study is subject to the following licenses/restrictions: The data is held by NHS Blood and Transplant, and may be available upon reasonable request. Requests to access these datasets should be directed to statistical.enquiries@nhsbt.nhs.uk.

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