title: The PROCARE consortium: toward an improved allocation strategy for kidney allografts.
abstract: Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time.
authors.affiliation: UMC Utrecht, Laboratory for Translational Immunology, The Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: Otten
authors.affiliation: Radboudumc, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Joosten
authors.affiliation: Radboudumc, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Allebes
authors.affiliation: Radboudumc, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van der Meer
authors.affiliation: Radboudumc, Dept. of Nephrology, The Netherlands.
authors.forename: L B
authors.initials: LB
authors.lastname: Hilbrands
authors.affiliation: Radboudumc, Dept. of Nephrology, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Baas
authors.affiliation: UMC Utrecht, Laboratory for Translational Immunology, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Spierings
authors.affiliation: UMC Utrecht, Laboratory for Translational Immunology, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Hack
authors.affiliation: UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Reekum
authors.affiliation: UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands.
authors.forename: A D
authors.initials: AD
authors.lastname: van Zuilen
authors.affiliation: UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Verhaar
authors.affiliation: UMC Utrecht, Julius Center for Health Sciences and Primary Care, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: UMCG, Dept. of Nephrology, The Netherlands.
authors.forename: M A J
authors.initials: MA
authors.lastname: Seelen
authors.affiliation: UMCG, Dept. of Nephrology, The Netherlands.
authors.forename: J S F
authors.initials: JS
authors.lastname: Sanders
authors.affiliation: UMCG, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: B G
authors.initials: BG
authors.lastname: Hepkema
authors.affiliation: UMCG, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lambeck
authors.affiliation: UMCG, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: L B
authors.initials: LB
authors.lastname: Bungener
authors.affiliation: UMCG, Dept. of Laboratory Medicine, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Roozendaal
authors.affiliation: Maastricht UMC, Transplantation Immunology, The Netherlands.
authors.forename: M G J
authors.initials: MG
authors.lastname: Tilanus
authors.affiliation: Maastricht UMC, Transplantation Immunology, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Vanderlocht
authors.affiliation: Maastricht UMC, Transplantation Immunology, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Voorter
authors.affiliation: Maastricht UMC, Transplantation Immunology, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Wieten
authors.affiliation: Maastricht UMC, Dept. of Nephrology, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van Duijnhoven
authors.affiliation: Maastricht UMC, Dept. of Nephrology, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Gelens
authors.affiliation: Maastricht UMC, Dept. of Nephrology, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Christiaans
authors.affiliation: VUmc, Dept. of Nephrology, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Ittersum
authors.affiliation: VUmc, Dept. of Nephrology, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Nurmohamed
authors.affiliation: Sanquin, Dept. of Immunogenetics, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: Lardy
authors.affiliation: Sanquin, Dept. of Immunogenetics, The Netherlands.
authors.forename: W T
authors.initials: WT
authors.lastname: Swelsen
authors.affiliation: AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands.
authors.forename: K A M I
authors.initials: KA
authors.lastname: van Donselaar-van der Pant
authors.affiliation: AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: van der Weerd
authors.affiliation: AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands.
authors.forename: I J M
authors.initials: IJ
authors.lastname: Ten Berge
authors.affiliation: AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Bemelman
authors.affiliation: NOTR/NTS Leiden, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hoitsma
authors.affiliation: LUMC, Dept. of Nephrology, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: de Fijter
authors.affiliation: Erasmus MC, Dept. of Nephrology, The Netherlands.
authors.forename: M G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: LUMC, Immunohematology and Blood Transfusion, The Netherlands.
authors.forename: D L
authors.initials: DL
authors.lastname: Roelen
authors.affiliation: LUMC, Immunohematology and Blood Transfusion, The Netherlands.
authors.forename: F H J
authors.initials: FH
authors.lastname: Claas
mesh_terms: D018985:Epitopes, B-Lymphocyte / Q000276:immunology; D018984:Epitopes, T-Lymphocyte / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D011788:Quality of Life; D006435:Renal Dialysis; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists
chemical_list: D018985:Epitopes, B-Lymphocyte; D018984:Epitopes, T-Lymphocyte; D006680:HLA Antigens
keywords: Autoantibodies; Gene polymorphisms; HLA antibodies; Kidney transplantation; T and B cell epitopes