title: Does a kidney-sharing alliance have to sacrifice cold ischemic time for better HLA matching?
abstract: BACKGROUND
  The Scotland-Northern Ireland Kidney Allocation Alliance was created in August 1998. The purpose was to optimize the transplant service through increased regional exchange, higher quality matched kidneys, and better organ distribution.
  
  
  METHODS
  An analysis was performed on prospectively collected data regarding retrieval and transplant activity. The degree of HLA matching, the cold ischemic time (CIT), the balance of exchange, and graft survival were analyzed for a 2-year period after the introduction of the new alliance and compared with the last year before alliance.
  
  
  RESULTS
  There was a 17.7% increase in the number of transplants performed. In the 2-year period, 78% of kidneys were exported from the retrieving center compared with 55% in the prealliance year, (P<0.05, chi2). The proportion of 000 mismatched transplants and other favorable matches increased from 9.5 to 21% and from 52.5 to 61%, respectively. There was no significant difference between the CIT for the three study periods, nor between the CIT for locally used kidneys versus those exchanged within the Alliance (P>0.05, Student's t test). The largest center was a net importer of kidneys, whereas small and medium-sized centers balanced their exchange within the 2-year period. The 1-year transplant survival rate improved from 81.5% in the prealliance year to 88.4% at the end of the second year.
  
  
  CONCLUSIONS
  The introduction of a regional kidney allocation alliance has improved the degree of HLA matching and increased the exchange of organs, without a significant increase in the CIT and any detrimental effect on graft survival.
authors.affiliation: Renal Transplant Unit, The Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Oniscu
authors.forename: William
authors.initials: W
authors.lastname: Plant
authors.forename: Phil
authors.initials: P
authors.lastname: Pocock
authors.forename: John L R
authors.initials: JL
authors.lastname: Forsythe
mesh_terms: D006650:Histocompatibility Testing; D006801:Humans; D007511:Ischemia; D007668:Kidney; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data*; D009926:Organ Preservation / Q000379:methods; D018579:Patient Selection; D012079:Renal Circulation; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome