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Sensitized patients require sharing of highly matched kidneys
Thomas R McCune1, Leroy R Thacker, John W Blanton
1Nephrology Associates of Tidewater, Medical College of Hampton Roads, USA.
Transplantation
|July 20, 2002
Summary
Removing HLA matching points may not impact graft survival but could reduce transplant options for highly sensitized patients. This affects retransplant and high PRA candidates.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Improved human leukocyte antigen (HLA) matching enhances renal transplant success in sensitized patients.
- The United Network for Organ Sharing (UNOS) is evaluating the removal of HLA matching points.
Purpose of the Study:
- To assess the impact of HLA matching criteria on renal transplant outcomes.
- To evaluate the effect of removing HLA matching points on graft survival and transplant opportunities.
Main Methods:
- A kidney sharing program involving 26 transplant centers was implemented.
- Transplant algorithms included UNOS mandatory 0-mismatch shares, paybacks, and varying levels of HLA and donor-specific antibody matching.
- Outcomes were compared between 354 transplanted patients and 6492 control patients.
Main Results:
- Highly sensitized patients experienced a greater primary nonfunction rate despite similar cold ischemia times.
- The HLA matching program did not significantly disadvantage Black recipients but favored White recipients over "other" racial groups.
- While women were more frequent in sensitized groups, they did not benefit from sharing; retransplant and high PRA (>40%) patients were favored.
- Sharing based on HLA matching did not improve 1-, 2-, or 3-year graft survival.
Conclusions:
- Eliminating suboptimal HLA matching by UNOS is unlikely to negatively impact 1-, 2-, and 3-year graft survival.
- Removing HLA matching considerations may decrease transplant opportunities for highly sensitized patients, including retransplant recipients and those with high panel reactive antibodies.