¿Debería Continuar la Prioridad Actual de Cero Desajustes HLA ABDR en el Sistema de Asignación de Riñón?: Una...

In the Kidney Allocation System (KAS), adult kidney candidates who are a zero Human Leukocyte Antigen (HLA) ABDR-mismatch with a potential donor are given priority in the match run over non-zero HLA ABDR-mismatch candidates. Furthermore, KAS allows for the shunting of kidneys to zero-mismatch candidates across compatible ABO blood types, potentially disadvantaging O candidates who have longer waiting times. This study was undertaken to determine who is receiving zero HLA ABDR-mismatch kidneys, the number of donors shunted to non-identical ABO recipients, the impact on dialysis exposure before transplant, and the current patient and graft outcomes.

All adult deceased donor kidney recipients since the start of KAS on 12/4/2014 were included in the study. Multi-organ transplants with a kidney, 98-100% Calculated Panel Reactive Antibodies (CPRA), previous living donors, pediatric, medically urgent, and safety net transplants were excluded. Patients were considered a zero-mismatch allocation if they received a zero HLA ABDR-mismatch kidney and had an allocation CPRA less than 98%. 122,951 adult deceased-donor kidney transplants were in the study population. 6228, or 5.1%, were zero HLA ABDR-mismatch recipients.

The zero HLA ABDR-mismatch recipients were predominantly of the White race, female, had lower allocation CPRAs, much shorter dialysis exposure, and were more likely to be retransplant recipients. 1441 blood type O donors were shunted to other ABO groups, or 2.46% of O donors. Cox analysis of graft and patient survival showed that zero HLA ABDR-mismatch recipients had a small graft survival advantage (0.898, 0.834-0.967, p=0.004) and no patient survival advantage (0.947, 0.865-1.037, p=0.239). The adjusted graft survival at 7 years was 67% (zero HLA-ABDR mismatch) versus 65% (non-zero HLA-ABDR mismatch).

The current zero HLA ABDR-mismatch priority is highly biased against racial minority recipients, shunts a sizable number of O donors to non-O recipients, only makes a small improvement to organ utility, and should be removed from the allocation priority list.