title: Persistently low transplantation rate of ABO blood type O and highly sensitised patients despite alternative transplantation programs.
abstract: ABO blood type O and highly sensitised patients have the smallest chance to receive kidney transplantation. Do alternative donation programs increase this chance? In the period studied: 2323 patients were enlisted on the Rotterdam waiting list for a renal transplantation: 435 patients still waiting (WL), 464 delisted without transplantation (DWT). 1424 received deceased donor (DD, 535) or living donor (LD, 889, including 204 alternative) transplantation. Alternative LD programs in our centre are: paired kidney-exchange, altruistic with domino-paired donation and ABO-incompatible donation (ABOi). Compared to populations not transplanted, blood type O recipients are significantly underrepresented in DD and all LD transplantation populations, except the ABOi program. Highly sensitised patients are overrepresented in DD, but underrepresented in all LD transplantation populations. The high transplantation rate of highly sensitised patients was the result of Eurotransplant Acceptable mismatch program (AM). The LD ABOi and DD AM programs are the only alternative donation programs favourable for patients with low chances. While the contribution of direct LD transplantations will increase in time, the relative success rate of low-chance patients will decrease. Beside increasing LD ABOi transplantation, a new DD allocation model favouring both highly immunised and blood type O patients is essential.
authors: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. j.roodnat@erasmusmc.nl
authors: Joke I
authors: JI
authors: Roodnat
authors: Jacqueline
authors: J
authors: van de Wetering
authors: Frans H
authors: FH
authors: Claas
authors: Jan
authors: J
authors: Ijzermans
authors: Willem
authors: W
authors: Weimar
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility; D005060:Europe; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D016377:Organ Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000628:therapy*; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000706:statistics & numerical data; D014850:Waiting Lists
chemical_list: D000017:ABO Blood-Group System