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Hyperimmunized patients do not need to wait for an HLA identical donor
F H Claas1, A van Leeuwen, J J van Rood
1Department of Immunohaematology, University Hospital Leiden, The Netherlands.
Tissue Antigens
|July 1, 1989
Summary
Hyperimmunized patients face long waits for kidney transplants due to high sensitization. A strategy using "acceptable mismatches" based on Human Leukocyte Antigen (HLA) compatibility improves donor selection for these patients.
Area of Science:
- Immunology
- Transplantation Medicine
- Nephrology
Background:
- Hyperimmunized patients often remain on renal transplant waiting lists.
- High levels of sensitization result in positive crossmatches with most potential organ donors, complicating transplantation.
- Understanding sensitization origins is crucial for improving donor selection.
Purpose of the Study:
- To discuss the origins of sensitization in kidney transplant candidates.
- To review strategies for identifying crossmatch-negative donors for highly sensitized patients.
- To emphasize a local strategy for selecting compatible kidney donors.
Main Methods:
- Identifying Human Leukocyte Antigen (HLA)-A and -B mismatches against which patients have not developed allo-antibodies (acceptable mismatches).
- Kidney donor selection based on compatibility with the patient's HLA antigens and acceptable HLA-A and -B antigens.
- Centralized operation of donor selection through an organ-sharing office.
Main Results:
- A local strategy utilizing acceptable HLA-A and -B mismatches can facilitate donor selection.
- Acceptable HLA mismatches frequently align with or include non-inherited maternal antigens (NIMA).
- This approach aids in finding suitable donors for hyperimmunized individuals.
Conclusions:
- The strategy of using acceptable HLA mismatches improves donor availability for hyperimmunized renal transplant candidates.
- Non-inherited maternal antigens (NIMA) play a role in defining acceptable HLA mismatches.
- This method offers a practical solution for reducing wait times and improving transplant outcomes.