CREG matching for first cadaveric kidney transplants (TNX) performed by SEOPF centers between October 1987 and September 1995. Southeastern Organ Procurement Foundation.
The Southeastern Organ Procurement Foundation (SEOPF) data base from October 1987 to September 1995 included 12,536 first cadaveric kidney transplants, of which 39.5% were placed into non-white recipients (N-WR). Consequently, the SEOPF data offered an excellent sample in which to examine the effect of a number of conventional HLA-A, B versus public (crossreactive group, CREG) matching schemes on access and graft survival (GS). The standard applied was that 3-yr GS had to be greater than that of the mean GS of the racial group. Because of the excellent 1- and 3-yr GS of 0 A, B, DR mismatched kidneys in both white recipients (WR) = 87.9% and 82.8% and N-WR = 86.9% and 80.9%, these transplants were excluded from further analysis. Thereafter, the mean 1- and 3-yr GS of the remaining 7011 WR and 4862 N-WR, transplants used for all subsequent comparisons were 82.5% and 72.4% for WR versus 80.9% and 63.0% for N-WR. Four different matching schemes were compared: 1) Class I A, B versus CREG hierarchical effect disregarding DR; 2) 0, 1, 2B, DR versus 0-2 CREG, DR mismatching; 3) DR mismatching disregarding Class I A, B or CREG mismatching and 4) Class I A, B versus CREG mismatching stratified for DR. Two and possibly three CREG, DR mismatched groups were identified in which improved access and GS occurred in comparison with the 0, 1, and 2B, DR mismatched transplants currently receiving 7, 3 and 1 point in the UNOS sharing algorithm. The 1- and 3-yr GS in WR and N-WR of these groups were as follows: 0 CREG, 0 DR mismatches: 85.7% and 78.3% in WR (n = 385); 83.0% and 69.4% in N-WR (n = 157). 1-3 CREG, 0 DR mismatches: 84.5% and 74% in WR (n = 1550); 82.7% and 65.7% in N-WR (n = 1083). Based on this analysis, there may be a significant potential advantage of prospective Class I CREG over A, B matching for first cadaver kidney transplantation.
Thompson
J S
JS
Department of Medicine, University of Kentucky, Lexington, USA.
Thacker
L R
LR
D000465:Algorithms; D003429:Cross Reactions; D005500:Follow-Up Studies; D006085:Graft Survival; D006297:Health Services Accessibility; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D044469:Racial Groups; D015144:Southeastern United States; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous; D014850:Waiting Lists