Computer analysis of cadaver kidney allocation procedures.
Data of 32,000 donors were utilized for a computer simulation to analyze the effect of selection parameters on the outcome of kidney transplants. If the HLA match grade is considered for organ allocation, the overall 1-year graft survival rate is up to 7% higher for first cadaver transplants and up to 12% higher for second transplants than if HLA matching is disregarded. This solely success-oriented organ allocation method, however, leads to prolonged waiting times for patients with rare HLA phenotypes. We developed a selection procedure that yields results near the theoretical optimum: 95% of all patients can be transplanted with 0-2 HLA-A, -B, -DR antigen mismatches, the average waiting time decreases to 20 months, and no patient needs to wait longer for a transplant than 6 years. The overall graft survival rate is only 0.4% lower than the rate obtainable with strictly HLA-oriented allocation. The method prevents "poorly matchable" patients from accumulating on the waiting list. Additionally, the unfavorable race ratio in the North American recipient pool can be largely normalized.
Wujciak
T
T
Department of Transplantation Immunology, University of Heidelberg, Germany.
Opelz
G
G
D002102:Cadaver; D003198:Computer Simulation; D015234:HLA-A Antigens / Q000032:analysis; D015235:HLA-B Antigens / Q000032:analysis; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D008954:Models, Biological; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*
D015234:HLA-A Antigens; D015235:HLA-B Antigens