BACKGROUND: The benefits of HLA-A, B, and DR matching of cadaveric kidney grafts and recipients remain controversial when viewed from the perspective of social equity and graft survival. METHODS: We estimated graft survival using proportional-hazards techniques, adjusting for patient and donor characteristics, for a series of 30,564 Medicare patients receiving a first cadaveric kidney transplant between 1984 and 1990. The effects of minimal achievable HLA mismatches and maximal matching on graft survival were estimated by simulated allocation of a sample of organs to a sample of 20,000 candidates for transplantation. RESULTS: The adjusted one-year graft survival was 84.3 percent for grafts with no mismatches and 77.0 percent for grafts with four mismatches. National rationing of donor organs to achieve minimal mismatching and maximal matching could potentially decrease the average number of HLA mismatches from 3.6 to 1.2, with a corresponding increase in the number of matches. As a consequence, projected five-year graft survival could potentially increase from 58.5 percent to 62.9 percent. This would be associated with a decrease in the proportion of kidneys allocated to black recipients from 22.2 to 15.0 percent. CONCLUSIONS: Under ideal circumstances, a policy of maximal matching of cadaveric renal transplants would increase five-year graft survival by a comparatively small 4.4 percentage points, but the actual benefit is likely to be smaller.
BACKGROUND: The benefits of HLA-A, B, and DR matching of cadaveric kidney grafts and recipients remain controversial when viewed from the perspective of social equity and graft survival. METHODS: We estimated graft survival using proportional-hazards techniques, adjusting for patient and donor characteristics, for a series of 30,564 Medicare patients receiving a first cadaveric kidney transplant between 1984 and 1990. The effects of minimal achievable HLA mismatches and maximal matching on graft survival were estimated by simulated allocation of a sample of organs to a sample of 20,000 candidates for transplantation. RESULTS: The adjusted one-year graft survival was 84.3 percent for grafts with no mismatches and 77.0 percent for grafts with four mismatches. National rationing of donor organs to achieve minimal mismatching and maximal matching could potentially decrease the average number of HLA mismatches from 3.6 to 1.2, with a corresponding increase in the number of matches. As a consequence, projected five-year graft survival could potentially increase from 58.5 percent to 62.9 percent. This would be associated with a decrease in the proportion of kidneys allocated to black recipients from 22.2 to 15.0 percent. CONCLUSIONS: Under ideal circumstances, a policy of maximal matching of cadaveric renal transplants would increase five-year graft survival by a comparatively small 4.4 percentage points, but the actual benefit is likely to be smaller.
Authors: A J Demetris; N Murase; R G Lee; P Randhawa; A Zeevi; S Pham; R Duquesnoy; J J Fung; T E Starzl Journal: Ann Transplant Date: 1997 Impact factor: 1.530
Authors: A B Massie; J Leanza; L M Fahmy; E K H Chow; N M Desai; X Luo; E A King; M G Bowring; D L Segev Journal: Am J Transplant Date: 2016-02-26 Impact factor: 8.086
Authors: Sheryl Stogis; Richard A Hirth; Robert L Strawderman; Jane Banaszak-Holl; Dean G Smith Journal: Health Serv Res Date: 2002-10 Impact factor: 3.402
Authors: Stefan O Ciurea; Peter F Thall; Xuemei Wang; Sa A Wang; Ying Hu; Pedro Cano; Fleur Aung; Gabriela Rondon; Jeffrey J Molldrem; Martin Korbling; Elizabeth J Shpall; Marcos de Lima; Richard E Champlin; Marcelo Fernandez-Vina Journal: Blood Date: 2011-10-03 Impact factor: 22.113
Authors: Stefan O Ciurea; Marcos de Lima; Pedro Cano; Martin Korbling; Sergio Giralt; Elizabeth J Shpall; Xuemei Wang; Peter F Thall; Richard E Champlin; Marcelo Fernandez-Vina Journal: Transplantation Date: 2009-10-27 Impact factor: 4.939