1. A New HLA Allocation Procedure of Kidneys From Deceased Donors in the Current Era of Immunosuppression.
- Author
-
Broeders, N., Racapé, J., Hamade, A., Massart, A., Hoang, A.D., Mikhalski, D., Le Moine, A., and Vereerstraeten, P.
- Subjects
- *
KIDNEY transplantation , *HLA histocompatibility antigens , *IMMUNOSUPPRESSION , *BIOCOMPATIBILITY , *ANTILYMPHOCYTIC serum , *GLOBULINS , *MYCOPHENOLIC acid - Abstract
Introduction 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. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF