PMID- 20571466
OWN - NLM
STAT- MEDLINE
DCOM- 20100903
LR  - 20211020
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 90
IP  - 3
DP  - 2010 Aug 15
TI  - HLA-A, -B, and -DR zero-mismatched kidneys shipped to the University of 
      Wisconsin, Madison, 1993-2006: superior graft survival despite longer 
      preservation time.
PG  - 312-8
LID - 10.1097/TP.0b013e3181e49b9f [doi]
AB  - BACKGROUND: To determine the impact at a single center of the United Network for 
      Organ Sharing-mandated sharing program for human leukocyte antigen (HLA)-A/-B/-DR 
      0-mismatched (0MM) kidneys, we analyzed the results of 264 kidney transplants 
      from 0MM distant donors between 1993 and 2006, with a follow-up through January 
      31, 2007. We compared these results with that of concurrent kidneys transplanted 
      from HLA more than 0MM local donors and with shipped more than 0MM kidneys from 
      "payback" donors. RESULTS: Despite a significantly longer preservation time, we 
      found an 11% increase in 8-year graft survival (63% vs. 52%; P<0.003) of 0MM 
      shipped versus locally procured, >0MM donor kidneys. Graft survival of 0MM 
      shipped kidneys at 8 years was significantly better in nonsensitized (<20% panel 
      reactive antibodies; 68% vs. 55%; P<0.0005) but not in sensitized (>or=20% panel 
      reactive antibodies) recipients, who showed an early (2 years) but short-lived 
      benefit. The benefit of receiving a HLA-A, -B, and -DR 0MM shipped kidney 
      remained strong and statistically significant (0.71 relative risk of graft loss 
      vs. local; P<0.02) when adjusted for 22 potentially confounding variables in a 
      Cox proportional hazards analysis. CONCLUSIONS: The recent change in United 
      Network for Organ Sharing policy restricting mandated sharing of 0MM kidneys to 
      sensitized and pediatric recipients will give greater flexibility to the local 
      organ procurement organization in allocating organs. However, the survival 
      benefit to nonsensitized patients is real and long lasting and will be lost.
FAU - Burlingham, William J
AU  - Burlingham WJ
AD  - Department of Surgery, University of Wisconsin School of Medicine and Public 
      Health, Madison, WI 53792-7375, USA. burlingham@surgery.wisc.edu
FAU - Munoz del Rio, Alejandro
AU  - Munoz del Rio A
FAU - Lorentzen, David
AU  - Lorentzen D
FAU - Sollinger, Hans W
AU  - Sollinger HW
FAU - Pirsch, John D
AU  - Pirsch JD
FAU - Jankowska-Gan, Ewa
AU  - Jankowska-Gan E
FAU - D'Alessandro, Anthony
AU  - D'Alessandro A
LA  - eng
GR  - R01 AI066219/AI/NIAID NIH HHS/United States
GR  - R21 DK077354/DK/NIDDK NIH HHS/United States
GR  - R21-DK077354-02/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Cold Ischemia
MH  - *Donor Selection
MH  - Female
MH  - *Graft Survival
MH  - HLA Antigens/*immunology
MH  - HLA-A Antigens/immunology
MH  - HLA-B Antigens/immunology
MH  - HLA-DR Antigens/immunology
MH  - Health Care Rationing
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - *Organ Preservation
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Universities
MH  - Wisconsin
MH  - Young Adult
PMC - PMC3182673
MID - NIHMS320317
EDAT- 2010/06/24 06:00
MHDA- 2010/09/04 06:00
PMCR- 2011/09/29
CRDT- 2010/06/24 06:00
PHST- 2010/06/24 06:00 [entrez]
PHST- 2010/06/24 06:00 [pubmed]
PHST- 2010/09/04 06:00 [medline]
PHST- 2011/09/29 00:00 [pmc-release]
AID - 10.1097/TP.0b013e3181e49b9f [doi]
PST - ppublish
SO  - Transplantation. 2010 Aug 15;90(3):312-8. doi: 10.1097/TP.0b013e3181e49b9f.