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Nephrol Dial Transplant. 2017 May 1;32(5):880-889. doi: 10.1093/ndt/gfw462.

Unacceptable human leucocyte antigens for organ offers in the era of organ shortage: influence on waiting time before kidney transplantation.

Author information

1
Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538?Lübeck, Germany.
2
Institute of Medical Biometry and Statistics, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
3
HLA Laboratory, Center for Tumor Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
4
Department of Transfusion Medicine, Ludwig-Maximilians-University München, Munich, Germany.
5
Institute of Transfusion Medicine, Kliniken der Stadt Köln, Cologne, Germany.
6
Medizinische Klinik m. S. Nephrologie, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
7
Clinic for Nephrology, Charité Campus Virchow-Klinikum, Berlin, Germany.
8
Department of Nephrology, University Hospital Essen, Essen, Germany.
9
Medizinische Klinik D, University Hospital Münster, Münster, Germany.
10
Department of Surgery, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.
11
Medizinische Klinik I, University Hospital Marien Hospital Herne, Herne, Germany.
12
Medizinische Klinik I, Kliniken der Stadt Köln, Cologne, Germany.
13
Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
14
Transplant Center, Ludwig-Maximilians-University München, Munich, Germany.
15
Department of Nephrology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
16
Transplant Center Cologne, University of Cologne, Cologne, Germany.
17
Medizinische Klinik I, University Hospital Bonn, Bonn, Germany.
18
Transplant Center, Klinikum Augsburg, Augsburg, Germany.
19
Transplant Center, University Hospital of Schleswig-Holstein, Lübeck, Germany.
20
Department of Nephrology, University Hospital of Schleswig-Holstein, Kiel, Germany.
21
Institute for Transfusion Medicine, University Hospital Essen, Essen, Germany.
22
Institute of Transfusion Medicine and Transplantation Immunology, University Hospital Münster, Münster, Germany.

Abstract

Background:

The assignment of human leucocyte antigens (HLAs) against which antibodies are detected as unacceptable antigens (UAGs) avoids allocation of HLA- incompatible allografts. There is uncertainty as to what extent UAGs decrease the probability of receiving a kidney offer.

Methods:

Kidney transplantations in 3264 patients on the waiting lists of six German transplant centres were evaluated for a period of at least 2 years. The proportion of excluded offers due to UAGs was calculated as virtual panel-reactive antibodies (vPRAs).

Results:

In the common Eurotransplant Kidney Allocation Scheme, the transplant probability was unaffected by vPRAs in exploratory univariate analyses. In the multivariable model, a 1% increase in vPRA values was outweighed by an additional waiting time of 2.5 weeks. The model was confirmed using an external validation cohort of 1521 patients from seven centres. If only patients with standard risk were considered (e.g. no simultaneous transplantation of other organs), only 1.3 weeks additional waiting time was needed. In the Eurotransplant Senior Program, patients with vPRA values >50% had a strongly reduced transplant probability in the unadjusted analyses. In the multivariable model, a 1% increase in vPRA values was outweighed by an additional waiting time of 5 weeks.

Conclusions:

This study demonstrates that the assignment of UAGs decreases the transplant probability in both main Eurotransplant allocation programs because of insufficient compensatory mechanisms. At present, for immunized patients, a prolonged waiting time has to be weighed against the increased immunologic risk due to donor-specific antibodies not assigned as UAGs.

KEYWORDS:

HLA antibodies; kidney transplantation; unacceptable HLA antigens; virtual PRAs; waiting time

PMID:
28340245
DOI:
10.1093/ndt/gfw462
[Indexed for MEDLINE]

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