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Am J Transplant. 2019 Jun 2. doi: 10.1111/ajt.15486. [Epub ahead of print]

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to non-sensitized patients.

Author information

1
Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, The Netherlands.
2
Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
3
Radboud university medical center, Radboud Institute for Molecular Life Sciences, Laboratory Medicine, Laboratory of Medical Immunology, Nijmegen, the Netherlands.
4
Radboud university medical center, Radboud Institute for Health Sciences, Department of Nephrology, Nijmegen, The Netherlands.
5
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
6
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
7
Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
8
Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
9
Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands.
10
Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands.
11
Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Nephrology, Amsterdam, The Netherlands.
12
Department of Immunogenetics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
13
Amsterdam University Medical Center, University of Amsterdam, Department of Internal Medicine, Renal Transplant Unit, Amsterdam, The Netherlands.
14
Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands.
15
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
16
Department of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
17
Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, determined by extensive laboratory testing. AM patients have superior long-term graft survival compared to highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants 1995-2005, we selected deceased donor single transplants with minimum one HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of one HLA-B plus one HLA-DR, or two HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to non-sensitized patients, independent of other risk factors for rejection. Contrasting to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low risk transplants for highly sensitized patients with rejection rates similar to non-immunized individuals. This article is protected by copyright. All rights reserved.

PMID:
31155833
DOI:
10.1111/ajt.15486

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