PMID- 17496537
OWN - NLM
STAT- MEDLINE
DCOM- 20070628
LR  - 20101118
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 83
IP  - 9
DP  - 2007 May 15
TI  - Simpler and equitable allocation of kidneys from postmortem donors primarily 
      based on full HLA-DR compatibility.
PG  - 1207-13
AB  - BACKGROUND: The introduction of human leukocyte antigen (HLA)-matching in 
      nonliving kidney transplantation has resulted into a better graft outcome, but 
      also in an increase of waiting time, especially for patients with rare HLA 
      phenotypes. We addressed the question of the differential influence of 
      HLA-DR-matching versus HLA-A,B in clinical kidney transplantation. METHODS: We 
      used Kaplan-Meier product limit method to estimate survival rates, and Cox 
      proportional hazard regression for the estimation of relative risks 
      (Hazard-ratios) for different variables. RESULTS: A single center study (n=456 
      transplants, performed between 1985 and 1999) showed that full HLA-DR 
      compatibility leads to a lower incidence of biopsy confirmed acute rejections in 
      the first 180 posttransplantation days. These results were substantiated using 
      the Eurotransplant database (n=39,205 transplants performed between 1985 and 
      2005) where graft survival in the full HLA-DR compatible group was significantly 
      better than in the incompatible. An additional positive effect of HLA-A,B 
      matching was only found in the full HLA-DR compatible group. In both studies, the 
      introduction of a single HLA-DR incompatibility eliminates the HLA-A,B matching 
      effect. CONCLUSIONS: We propose to allocate postmortem kidneys only to patients 
      with full HLA-DR compatibility, and use HLA-A,B compatibility as an additional 
      selection criterion. All patients, irrespective of their ethnic origin, will 
      profit since the polymorphism of HLA-DR is by far lower than that of HLA-A,B. 
      Excessive kidney travel and cold ischemia time will be significantly reduced.
FAU - Doxiadis, Ilias I N
AU  - Doxiadis II
AD  - Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, 
      the Netherlands. doxiadis@lumc.nl
FAU - de Fijter, Johan W
AU  - de Fijter JW
FAU - Mallat, Marko J K
AU  - Mallat MJ
FAU - Haasnoot, Geert W
AU  - Haasnoot GW
FAU - Ringers, Jan
AU  - Ringers J
FAU - Persijn, Guido G
AU  - Persijn GG
FAU - Claas, Frans H J
AU  - Claas FH
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
CIN - Nat Clin Pract Nephrol. 2007 Oct;3(10):536-7. PMID: 17700551
MH  - Acute Disease
MH  - Cadaver
MH  - Databases, Factual
MH  - Female
MH  - Graft Rejection/epidemiology
MH  - Graft Survival
MH  - HLA-A Antigens/blood
MH  - HLA-B Antigens/blood
MH  - HLA-DR Antigens/*blood
MH  - *Health Care Rationing
MH  - *Histocompatibility
MH  - Histocompatibility Testing
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Risk
MH  - Time Factors
MH  - *Tissue Donors
MH  - *Tissue and Organ Procurement
EDAT- 2007/05/15 09:00
MHDA- 2007/06/29 09:00
CRDT- 2007/05/15 09:00
PHST- 2007/05/15 09:00 [pubmed]
PHST- 2007/06/29 09:00 [medline]
PHST- 2007/05/15 09:00 [entrez]
AID - 00007890-200705150-00012 [pii]
AID - 10.1097/01.tp.0000261108.27421.bc [doi]
PST - ppublish
SO  - Transplantation. 2007 May 15;83(9):1207-13. doi: 
      10.1097/01.tp.0000261108.27421.bc.