Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients
Publication year
2019Author(s)
Source
American Journal of Transplantation, 19, 10, (2019), pp. 2926-2933ISSN
Publication type
Article / Letter to editor
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Organization
Nephrology
Laboratory Medicine
Paediatrics
Journal title
American Journal of Transplantation
Volume
vol. 19
Issue
iss. 10
Languages used
English (eng)
Page start
p. 2926
Page end
p. 2933
Subject
Radboudumc 0: Other Research RIMLS: Radboud Institute for Molecular Life Sciences; Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences; Radboudumc 5: Inflammatory diseases RIMLS: Radboud Institute for Molecular Life SciencesAbstract
Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.
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- Academic publications [238441]
- Electronic publications [122541]
- Faculty of Medical Sciences [90373]
- Open Access publications [97533]
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