Renal transplantation. Strategies to prevent organ rejection--the role of an inter-regional reference center.
This paper summarizes the role of the Inter-Regional Reference Center (RC) of the North Italy Transplant program (NITp), in coordinating a donor procurement and organ transplantation network, with a special focus on the strategies to minimize immunological risk and complications after transplantation. In the NITp, patients enrolled on the renal transplantation (RT) waiting list are typed for HLA-A,B,DRB1 antigens with a genomic method. They are periodically screened for the presence of lymphocytotoxic antibodies in their serum by the RC and their suitability to receive the transplant is checked periodically. Cadaver kidney allocation is ruled by a computerized algorithm, named NITK3, established in 1997, which aims at ensuring quality, equity, transparency and traceability during all the phases of the allocation decision-making process. NITK3 has been set up by the NITp Working Group on the basis of biological, medical and administrative criteria and it is periodically reviewed after the analysis of transplant results. In this paper, we show the results of a preliminary analysis of RTs performed from 1998 to 2002 in nine out of sixteen centers of the NITp area, which demonstrates the general quality of the NITp program in terms of patients and graft survival and the special attention to the patients at higher immunological risk.
Cardillo
Massimo
M
Dipartimento Trasfusionale e di Riferimento per il Trapianto di Organi e Tessuti, RCCS Ospedale Maggiore Policlinico, Milano; Italy.
Poli
Francesca
F
Barraco
Fiorenza
F
Fazio
Nicola De
N
Rossini
Giuseppe
G
Boschiero
Luigi
L
Nocera
Arcangelo
A
Rigotti
Paolo
P
Marchini
Francesco
F
Zacchello
Graziella
G
Zanon
Gianfranco
G
Sandrini
Silvio
S
Chiaramonte
Stefano
S
Maresca
Cristina
C
Caldara
Rossana
R
Messa
Piergiorgio
P
Berardinelli
Luisa
L
Ambrosini
Andrea
A
Montanaro
Domenico
D
Rampino
Teresa
T
Minetti
Enrico
E
Gotti
Eliana
E
Ghio
Luciana
L
Ginevri
Fabrizio
F
Albertario
Fulvio
F
Scalamogna
Mario
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D012042:Registries; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014850:Waiting Lists