title: A new HLA allocation procedure of kidneys from deceased donors in the current era of immunosuppression.
abstract: BACKGROUND
  It has recently been proposed to replace the current Eurotransplant kidney allocation based primarily on mismatches (MM) at the 3 HLA loci by a simpler system based on full HLA-DR compatibility. The present study analyzes this system in the current era of immunosuppression.
  
  
  METHODS
  From 1999 to 2012, 723 renal grafts were performed on 586 patients who were treated with a calcineurin inhibitor, mycophenolate mofetil, and in most cases antilymphocyte globulins. Four groups of HLA MM were compared: (A) A+B 2-4/DR 1-2 MM (n = 397), (B) A+B 2-4 MM/DR 0 MM (n = 106), (C) A+B 0-1 MM/DR 1-2 MM (n = 138), and (D) A+B 0-1/DR 0 MM (n = 82).
  
  
  RESULTS
  Acute rejection episodes were less frequent during the first post-transplantation year in group D than in the other groups (P = .018). Patient survival was lower in group A than in the other groups (P = .008). Immunologic graft survival was higher in group D than in the other groups in univariate (P = .015) and multivariate analyses (P = .033; 96.4% vs 90.1% at 10 years).
  
  
  CONCLUSIONS
  In the current era of immunosuppression, allocation of kidneys from deceased donors could be performed primarily according to full DR compatibility then to the best A+B matching, affording excellent graft outcome to most recipients.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium. Electronic address: Nilufer.Broeders@erasme.ulb.ac.be.
authors.forename: N
authors.initials: N
authors.lastname: Broeders
authors.affiliation: Research Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Racapé
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Hamade
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Massart
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: A D
authors.initials: AD
authors.lastname: Hoang
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Mikhalski
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Le Moine
authors.affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Vereerstraeten
mesh_terms: D000704:Analysis of Variance; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000401:mortality*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D014019:Tissue Donors
chemical_list: D000961:Antilymphocyte Serum; D065095:Calcineurin Inhibitors; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid