A new HLA allocation procedure of kidneys from deceased donors in the current era of immunosuppression

Transplantation Proceedings
N BroedersP Vereerstraeten

Abstract

It has recently been proposed to replace the current Eurotransplant kidney allocation based primarily on mismatches (MM) at the 3 HLA loci by a simpler system based on full HLA-DR compatibility. The present study analyzes this system in the current era of immunosuppression. From 1999 to 2012, 723 renal grafts were performed on 586 patients who were treated with a calcineurin inhibitor, mycophenolate mofetil, and in most cases antilymphocyte globulins. Four groups of HLA MM were compared: (A) A+B 2-4/DR 1-2 MM (n = 397), (B) A+B 2-4 MM/DR 0 MM (n = 106), (C) A+B 0-1 MM/DR 1-2 MM (n = 138), and (D) A+B 0-1/DR 0 MM (n = 82). Acute rejection episodes were less frequent during the first post-transplantation year in group D than in the other groups (P = .018). Patient survival was lower in group A than in the other groups (P = .008). Immunologic graft survival was higher in group D than in the other groups in univariate (P = .015) and multivariate analyses (P = .033; 96.4% vs 90.1% at 10 years). In the current era of immunosuppression, allocation of kidneys from deceased donors could be performed primarily according to full DR compatibility then to the best A+B matching, affording excellent graft outcome to most recipients.

References

Dec 1, 1993·Transplantation·T Wujciak, G Opelz
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Oct 25, 2000·Transplantation·H U Meier-KriescheB Kaplan
Feb 14, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Herwig-Ulf Meier-KriescheBruce Kaplan
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Citations

Sep 30, 2016·International Reviews of Immunology·Helena SáManuel Santos Rosa
Jun 20, 2017·Advanced Drug Delivery Reviews·Rose DiLoretoIwijn De Vlaminck
Jan 7, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Volker AssfalgUwe Heemann
Oct 11, 2017·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Xinmiao ShiJie Ding
Dec 23, 2016·Frontiers in Immunology·Andrea A Zachary, Mary S Leffell

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