title: Effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups.
abstract: BACKGROUND
  HLA typing and the time a patient has spent on the waiting list are the primary criteria used to allocate cadaveric kidneys for transplantation in the United States. Candidates with no HLA-A, B, and DR mismatches are given top priority, followed by candidates with the fewest mismatches at the HLA-B and DR loci; this policy contributes to a higher transplantation rate among whites than nonwhites. We hypothesized that changing this allocation policy would affect graft survival and the racial balance among transplant recipients.
  
  
  METHODS
  We estimated the relative rates of kidney transplantation according to race resulting from the current allocation policy and racial differences in HLA antigen profiles, using a Cox model for the time from placement on the waiting list to transplantation. Another model, also adjusted for HLA-B and DR antigen profiles, estimated the relative rates of kidney transplantation that would result if the distribution of these antigen profiles were identical among the racial and ethnic groups. We also investigated the effect of HLA matching on the risk of graft failure, using a Cox model for the time from the first transplantation to graft failure. The results of the two analyses were used to estimate the change in the racial balance of transplantation and graft-failure rates that would result from the elimination of HLA-B matching or HLA-B and DR matching as a means of assigning priority.
  
  
  RESULTS
  Eliminating the HLA-B matching as a priority while maintaining HLA-DR matching as a priority would decrease the number of transplantations among whites by 4.0 percent (166 fewer transplantations over a one-year period), whereas it would increase the number among nonwhites by 6.3 percent and increase the rate of graft loss by 2.0 percent.
  
  
  CONCLUSIONS
  Removing HLA-B matching as a priority for the allocation of cadaveric kidneys could reduce the existing racial imbalance by increasing the number of transplantations among nonwhites, with only a small increase in the rate of graft loss.
authors.affiliation: University of California at San Francisco, San Francisco, CA 94143-0780, USA. robertsj@surgery.ucsf.edu
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bragg-Gresham
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Rush
authors.forename: James J
authors.initials: JJ
authors.lastname: Wynn
authors.forename: Dale A
authors.initials: DA
authors.lastname: Distant
authors.forename: Valarie B
authors.initials: VB
authors.lastname: Ashby
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Held
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: D005006:Ethnicity; D006085:Graft Survival / Q000276:immunology*; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D006291:Health Policy; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D044469:Racial Groups; D012042:Registries; D040841:Resource Allocation; D009927:Tissue and Organ Procurement; D014481:United States
chemical_list: D015235:HLA-B Antigens; D006684:HLA-DR Antigens