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Effectiveness of an organ-sharing program in providing zero HLA-A,B,DR mismatched kidneys for transplantation in
1Department of Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Pooling kidney transplant patients between hospitals significantly improves human leukocyte antigen (HLA) matching. This organ sharing strategy enhances donor-recipient compatibility, leading to better outcomes in kidney transplantation.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Effective human leukocyte antigen (HLA) matching is crucial for transplant success.
- Organ sharing between transplant centers can potentially improve donor-recipient matching.
Purpose of the Study:
- To evaluate the impact of organ sharing on kidney allocation from cadaveric donors.
- To assess HLA-A,B,DR matching between two major Taiwanese transplant centers: National Cheng Kung University Hospital (CKUH) and National Taiwan University Hospital (NTUH).
Main Methods:
- Utilized standard complement-dependent microcytotoxicity assays for HLA typing.
- Performed HLA-A,B,C typing on T lymphocytes and HLA-DR typing on B cells.
- Employed epitope matching for a more refined assessment of donor-recipient compatibility.
Main Results:
- Pooling patients from CKUH and NTUH increased the allocation rate of kidneys with 0-A,B,DR mismatch to 13.3%.
- Epitope matching further enhanced compatibility, achieving a 0-A,B cross-reactive epitope group and 0-DR mismatch allocation rate of 54.6% when patients were pooled.
- No significant benefit was observed when comparing allocation estimates from 10,000 potential bone marrow donors versus 88 cadaveric donors.
Conclusions:
- Patient pooling among regional transplant centers in Taiwan significantly improves HLA matching for kidney transplantation.
- Organ sharing strategies can enhance the effectiveness of organ donation programs.
- Improved HLA matching through pooled resources leads to better donor-recipient compatibility.
Purpose:
This study evaluated the effects of organ sharing on the allocation of kidneys from cadaveric donors to uremic patients from National Cheng Kung University Hospital (CKUH) and National Taiwan University Hospital (NTUH) who were waiting for kidney transplantation.
Methods:
Standard complement-dependent microcytotoxicity assays were used. Human leukocyte antigen (HLA)-A,B,C typing was performed on nylon-wool-enriched T lymphocytes. HLA-DR typing was performed on either nylon-wool-separated B cells or Dynabeads. Isolation of class II-positive cells was performed with commercial typing trays.
Results:
Organs were allocated from a total of 88 cadaveric donors to 320 patients treated at CKUH and 179 patients treated at NTUH. Cadaveric kidneys could be allocated with an A,B,DR mismatch to 6.9% of CKUH patients and to 4.7% of NTUH patients. When CKUH and NTUH patients were pooled, the total number of kidneys that could be allocated with 0-A,B,DR mismatch increased to 13.3% (p < 0.004). However, when allocation was assessed using 10,000 potential bone marrow donors instead of the 88 cadaveric donors, kidneys could have been allocated with 0-A,B,DR mismatch to 12% (p = 0.64) of patients. No significant benefit was found when allocation estimates from the 10,000 potential bone marrow donors were compared with those for the 88 cadaveric donors. Use of epitope matching resulted in a 0-A,B cross-reactive epitope group, and a 0-DR mismatch allocation rate of 36.4% in CKUH patients and 31.8% in NTUH patients. This rate increased to 54.6% (p < 0.001) when the patients from these hospitals were pooled.
Conclusion:
The results of this study demonstrate that the pooling of patients among regional transplant centers in Taiwan can significantly enhance the benefits of an organ donation program through better HLA matching.