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HLA-A, -B, and DR Mismatch and Outcomes After Simultaneous Pancreas-Kidney Transplantation in the Modern Era

Lookup NU author(s): Dr Sam Tingle, Dr George KourounisORCiD, Abdullah Malik, Emily Thompson, Steven White, Professor Neil SheerinORCiD, Professor Colin Wilson

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

Abstract

© 2026 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.Background: HLA mismatch is known to impact post-transplant outcomes following kidney-alone transplantation. However, the impact on kidney outcomes in the context of simultaneous pancreas-kidney (SPK) transplantation remains uncertain. This study aimed to assess the impact of HLA mismatch on SPK outcomes. Method: Adult SPK recipients in the UNOS STAR registry (2010–2023) were analysed. Re-transplants were excluded. Multivariable nonlinear regression models evaluated the impact of HLA mismatch on outcome. Results: In a cohort of 10,559 SPK recipients overall mismatch was frequent, with only 34 recipients (0.3%) having 0/0/0 mismatches across HLA-A, HLA-B, and HLA-DR. HLA-DR mismatch was not associated with pancreas or kidney graft survival at 5 years; two versus zero HLA-DR mismatches aHR = 1.015 (95% CI 0.828–1.243) for pancreas graft survival, and aHR = 0.946 (0.753–1.188) for kidney graft survival. HLA-DR mismatch was also not associated with pancreas or kidney acute rejection or 12-month eGFR. HLA-A and HLA-B mismatches also showed no association with any pancreas or kidney transplant outcomes. Three-way interaction analyses between HLA-A, B and DR demonstrated no evidence that mismatch at any locus affected outcomes, irrespective of mismatch level at the other loci. Conclusion: In first-time simultaneous pancreas–kidney transplantation, donor–recipient HLA mismatch was not associated with pancreas or kidney graft survival, rejection, or early renal function. These findings contrast with kidney-alone transplantation and suggest that classical HLA mismatch effects may be attenuated in the contemporary SPK setting. Prioritising HLA-based matching, including HLA-DR, is therefore unlikely to improve short- or medium-term post-transplant outcomes in first-time SPK transplantation.

Publication metadata

Author(s): Sachdeva M, Tingle S, Kourounis G, Malik A, Thompson E, White S, Sheerin NS, Wilson C

Publication type: Article

Publication status: Published

Journal: Clinical Transplantation

Year: 2026

Volume: 40

Issue: 8

Online publication date: 24/08/2026

Acceptance date: 08/08/2026

Date deposited: 08/09/2026

ISSN (print): 0902-0063

ISSN (electronic): 1399-0012

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/ctr.70653

DOI: 10.1111/ctr.70653

Data Access Statement: The data used in the analysis are available from OPTN/UNOS. Data can be requested from OPTN/UNOS through the following website: https:// optn.transplant.hrsa.gov/data/view- data- reports/request-data/

PubMed id: 42638165

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