Simpler and equitable allocation of kidneys from postmortem donors primarily based on full HLA-DR compatibility.
BACKGROUND
The introduction of human leukocyte antigen (HLA)-matching in nonliving kidney transplantation has resulted into a better graft outcome, but also in an increase of waiting time, especially for patients with rare HLA phenotypes. We addressed the question of the differential influence of HLA-DR-matching versus HLA-A,B in clinical kidney transplantation.


METHODS
We used Kaplan-Meier product limit method to estimate survival rates, and Cox proportional hazard regression for the estimation of relative risks (Hazard-ratios) for different variables.


RESULTS
A single center study (n=456 transplants, performed between 1985 and 1999) showed that full HLA-DR compatibility leads to a lower incidence of biopsy confirmed acute rejections in the first 180 posttransplantation days. These results were substantiated using the Eurotransplant database (n=39,205 transplants performed between 1985 and 2005) where graft survival in the full HLA-DR compatible group was significantly better than in the incompatible. An additional positive effect of HLA-A,B matching was only found in the full HLA-DR compatible group. In both studies, the introduction of a single HLA-DR incompatibility eliminates the HLA-A,B matching effect.


CONCLUSIONS
We propose to allocate postmortem kidneys only to patients with full HLA-DR compatibility, and use HLA-A,B compatibility as an additional selection criterion. All patients, irrespective of their ethnic origin, will profit since the polymorphism of HLA-DR is by far lower than that of HLA-A,B. Excessive kidney travel and cold ischemia time will be significantly reduced.
Doxiadis
Ilias I N
II
Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, the Netherlands. doxiadis@lumc.nl
de Fijter
Johan W
JW
Mallat
Marko J K
MJ
Haasnoot
Geert W
GW
Ringers
Jan
J
Persijn
Guido G
GG
Claas
Frans H J
FH
D000208:Acute Disease; D002102:Cadaver; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D015234:HLA-A Antigens / Q000097:blood; D015235:HLA-B Antigens / Q000097:blood; D006684:HLA-DR Antigens / Q000097:blood*; D015276:Health Care Rationing; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens