title: HLA points assigned in cadaveric kidney allocation should be revisited: an analysis of HLA class II molecularly typed patients and donors.
abstract: The points now assigned for the quality of HLA match have received significant scrutiny to be modified in an effort to help reduce disparity in access to kidneys of minority groups, and since differences in graft survival between groups of patients in each of the HLA matched groups is less now than in the past. We analyzed long-term (5-year) graft survival in 746 DR DNA typed recipients of cadaveric kidneys transplanted from 1994-2001 whose donors were also DR DNA typed, with allocation based on those DNA-based typings. Five-year graft survival was not significantly different for recipient groups irrespective of if they had zero (84%), one (92%), two (89%), or three to four B, DR mismatches (79%) (log-rank = 0.15; died with a functioning graft [DWFG] censored). Mismatching of three and four DR and DQ antigens in black but not white patients was associated with significantly worse survival (Relative Risk = 2.9) (p = 0.002). The incidence of minority transplants in the well-matched group (zero and one B, DR mismatch), 12.8% (20/156) was over half that of the less well-matched group, 27.1% (160/590) (p < 0.001). Our data indicate that the current HLA-B, DR-based point system used to allocate kidneys warrants re-evaluation. Our data, taken in the context of the UNOS data, which has recently been re-evaluated, suggest that the only HLA-DR remain as a component of the national kidney allocation algorithm so as to increase access of kidneys to minorities and minimize graft loss.
authors.affiliation: Midwest Transplant Network, Westwood, KS, USA. cbryan@mwob.org
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Bryan
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harrell
authors.forename: Stanley I
authors.initials: SI
authors.lastname: Mitchell
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Mark I
authors.initials: MI
authors.lastname: Aeder
authors.forename: Alan M
authors.initials: AM
authors.lastname: Luger
authors.forename: Daniel
authors.initials: D
authors.lastname: Murillo
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Muruve
authors.forename: Paul W
authors.initials: PW
authors.lastname: Nelson
authors.forename: Charles F
authors.initials: CF
authors.lastname: Shield
mesh_terms: D002102:Cadaver; D005260:Female; D006085:Graft Survival; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D016133:Polymerase Chain Reaction; D009927:Tissue and Organ Procurement
chemical_list: D000949:Histocompatibility Antigens Class II