A model for human leukocyte antigen-matched donor-swap transplantation in India.
BACKGROUND
In developing countries such as India, extending donor-swap transplantation (DSTx) to human leukocyte antigen (HLA)-mismatched patient-donor pairs would increase well-matched living donor kidney transplantation rates, resulting in use of less immunosuppression and less expenses, lower infective morbidity, and better survival. A model for DSTx based on HLA matching is presented.


METHODS
Consecutive HLA class 1 antigen (A, B) tests of prospective renal allograft recipients and their related donors, performed at a single center in India was analyzed retrospectively using an HLA matching program to determine the proportion of prospective recipients with poorly matched related donors who could have benefited by DSTx based on HLA matching.


RESULTS
Over the past 17.5 years, 2,129 prospective renal allograft recipients and 2,890 donors were tested for HLA class I (A and B) antigens. Of the prospective recipients, 33% did not have well-matched donors (defined as blood group compatible and sharing > or =2 of 4 HLA class I antigens). Among such recipients, 19.2% could have found a well-matched donor-swap pair within a year at a single center. This number would increase to 38% if four major national centers were involved with a shared HLA registry.


CONCLUSIONS
Nearly 40% of prospective recipients without well-matched donors would find a donor-swap pair based on HLA matching within a year, with coordination among four national centers and a shared HLA registry, increasing the well-matched living donor renal transplant rates and improving transplant outcomes. This finding is relevant in the context of Indian government amending the Transplantation of Human Organs Act to encourage DSTx.
Basu
Gopal
G
Department of Nephrology, Christian Medical College, Vellore, India.
Daniel
Dolly
D
Rajagopal
Arunachalam
A
Neelakantan
Nithya
N
John
George T
GT
D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D006680:HLA Antigens / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007194:India; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D013997:Time Factors; D014850:Waiting Lists
D000017:ABO Blood-Group System; D006680:HLA Antigens; D015395:Histocompatibility Antigens Class I