BACKGROUND: Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African-American and other hard to match populations. Consequently, matching has been proposed of deduced amino acid residues of the individual HLA molecules shared by cross-reactive antigen groups (CREGs). We have examined the circumstances under which compatibility with either method impacted graft survival. METHODS: Using Cox proportional hazards regression modeling, we studied the relationship between levels of conventional HLA mismatch and other donor and recipient factors on primary cadaver kidney survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 (n=31,291). The results were compared with those obtained by the matching of amino acid residues that identified CREG-compatible cases with as many as four (but not five and six) HLA mismatches. RESULTS: With more than one HLA mismatch (> 85% of patients in both series), most of the survival advantage of a zero mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched recipients (35.3%) had better graft survival than the remaining 64.7%, who were CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA incompatibility tiers. Better graft survival with tacrolimus was observed in both the Pittsburgh and UNOS series. CONCLUSIONS: Obligatory national sharing of cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The potential value of CREG matching observed in the one-HLA-mismatched recipients of the UNOS (but not the Pittsburgh) experience deserves further study.
BACKGROUND: Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African-American and other hard to match populations. Consequently, matching has been proposed of deduced amino acid residues of the individual HLA molecules shared by cross-reactive antigen groups (CREGs). We have examined the circumstances under which compatibility with either method impacted graft survival. METHODS: Using Cox proportional hazards regression modeling, we studied the relationship between levels of conventional HLA mismatch and other donor and recipient factors on primary cadaver kidney survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 (n=31,291). The results were compared with those obtained by the matching of amino acid residues that identified CREG-compatible cases with as many as four (but not five and six) HLA mismatches. RESULTS: With more than one HLA mismatch (> 85% of patients in both series), most of the survival advantage of a zero mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched recipients (35.3%) had better graft survival than the remaining 64.7%, who were CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA incompatibility tiers. Better graft survival with tacrolimus was observed in both the Pittsburgh and UNOS series. CONCLUSIONS: Obligatory national sharing of cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The potential value of CREG matching observed in the one-HLA-mismatched recipients of the UNOS (but not the Pittsburgh) experience deserves further study.
Authors: T E Starzl; K A Porter; G Andres; C G Halgrimson; R Hurwitz; G Giles; P I Terasaki; I Penn; G T Schroter; J Lilly; S J Starkie; C W Putnam Journal: Ann Surg Date: 1970-09 Impact factor: 12.969
Authors: T E Starzl; J Fung; M Jordan; R Shapiro; A Tzakis; J McCauley; J Johnston; Y Iwaki; A Jain; M Alessiani Journal: JAMA Date: 1990-07-04 Impact factor: 56.272
Authors: Judith A Wade; Carolyn Katovich Hurley; Steven K Takemoto; John Thompson; Stella M Davies; Thomas C Fuller; Glenn Rodey; Dennis L Confer; Harriet Noreen; Michael Haagenson; Fangyu Kan; John Klein; Mary Eapen; Stephen Spellman; Craig Kollman Journal: Blood Date: 2007-01-03 Impact factor: 22.113
Authors: V Scantlebury; D Gjertson; M Eliasziw; P Terasaki; J Fung; R Shapiro; A Donner; T E Starzl Journal: Transplantation Date: 1998-02-27 Impact factor: 4.939
Authors: R Shapiro; M Nalesnik; J McCauley; S Fedorek; M L Jordan; V P Scantlebury; A Jain; C Vivas; D Ellis; S Lombardozzi-Lane; P Randhawa; J Johnston; T R Hakala; R L Simmons; J J Fung; T E Starzl Journal: Transplantation Date: 1999-12-27 Impact factor: 4.939
Authors: Marta Kot; Monika Baj-Krzyworzeka; Rafał Szatanek; Aleksandra Musiał-Wysocka; Magdalena Suda-Szczurek; Marcin Majka Journal: Int J Mol Sci Date: 2019-11-13 Impact factor: 5.923