The high grade match kidney sharing algorithm of the South-Eastern Organ Procurement Foundation (SEOPF): altering recipient demographics through improved matching.
BACKGROUND
Studies of kidneys shared through the South-Eastern Organ Procurement Foundation (SEOPF) have shown that regional organ procurement (ROP) trays can predict negative crossmatch in highly sensitized patients when the HLA match is of a high grade. In an attempt to offer more well-matched kidneys to highly sensitized patients, SEOPF organized the High Grade Match (HGM) Program.


METHODS
This United Network for Organ Sharing (UNOS)-approved allocation variance requires mandatory sharing of all kidneys by participating centers after UNOS mandatory sharing requirements have been met. The HGM levels of sharing are: (1) 0 A,B mismatch (MM); panel-reactive antibody (PRA) > or = 40%; negative ROP crossmatch; (2) 0 B,DR MM with > or = 40% PRA; negative ROP crossmatch; (3) 0 B,DR MM with PRA < 40%. Non-HGM cadaveric transplants at the same participating centers--locally or distally procured--serve as the control group.


RESULTS
During the first 18 months of this program, the 23 participating centers shared 124 kidneys of the 1592 that were available. Well-matched kidneys (two mismatches or less) accounted for 91.1% in the HGM group, but only 19% of the controls (P<0.0001). Highly sensitized patients (PRA > or = 40%) represented 13.8% of the HGM group, but only 3.3% of the non-HGM group (P<.0001). With HGM kidneys, there was a shift in recipient demographics. Patients with blood group O, female patients, older patients, and retransplanted patients all accounted for significantly larger percentages of the HGM group compared with the non-HGM control group. The racial composition of the recipients of high-grade matches was, however, no different than that of the control recipients at the same centers.


CONCLUSIONS
The HGM Program resulted in longer ischemia times, but graft survival was not affected. The 1-year actuarial graft survival rate (Kaplan-Meier) for HGM kidneys was not different from the control cadaveric graft survival rate. By sharing kidneys based on improved HLA matches with consideration for high PRA, the HGM Program offered more transplant opportunities to women, blood group O recipients, retransplants, and older patients.
McCune
T R
TR
Nephrology Associates of Tidewater, and Department of Internal Medicine, Medical College of Hampton Roads, Norfolk, Virginia, USA.
Blanton
J W
JW
Thacker
L R
LR
Adams
P A
PA
D000017:ABO Blood-Group System; D000206:Actuarial Analysis; D000328:Adult; D000367:Age Factors; D000465:Algorithms; D001788:Blood Grouping and Crossmatching; D002102:Cadaver; D003710:Demography; D005260:Female; D005582:Foundations; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012737:Sex Factors; D015144:Southeastern United States; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*
D000017:ABO Blood-Group System