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Acceptable HLA mismatches for highly immunized patients
F H Claas1, J De Meester, M D Witvliet
1Leiden University Medical Center, Department of Immunohaematology and Blood Bank, The Netherlands. ihbsecr@euronet.nl
Reviews in Immunogenetics
|March 21, 2001
Summary
Highly sensitized patients can now receive organ transplants through special programs. These strategies, including acceptable mismatch and highly immunized tray programs, significantly increase transplant success rates.
Area of Science:
- Immunogenetics
- Transplantation immunology
Background:
- Highly sensitized patients possess antibodies against numerous HLA antigens, complicating organ transplantation due to positive crossmatches.
- Positive crossmatches are contraindications for transplantation, severely limiting options for these patients.
Purpose of the Study:
- To evaluate the effectiveness of specialized strategies in increasing organ transplantation rates for highly sensitized patients.
Main Methods:
- Implementation of the acceptable mismatch program, involving extensive HLA antibody screening to identify compatible donors.
- Utilization of the highly immunized tray (HIT) program for crossmatching patient sera with ABO-compatible donors.
- Incorporation of enhanced waiting time points and HLA rarity factors in the standard allocation system.
Main Results:
- The acceptable mismatch program has facilitated over 300 transplants for highly sensitized patients.
- Despite these programs, approximately 25% of patients with rare HLA types still face challenges in receiving donor offers.
- The combined application of these three strategies significantly improves transplantation rates.
Conclusions:
- Specialized strategies, including acceptable mismatch, HIT program, and enhanced allocation points, are crucial for increasing organ transplant success in highly sensitized individuals.
- These multi-faceted approaches address the challenges posed by HLA antibodies and rare HLA types, expanding access to transplantation.