PMID- 36695620
OWN - NLM
STAT- MEDLINE
DCOM- 20230127
LR  - 20230202
IS  - 1600-6143 (Electronic)
IS  - 1600-6135 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Jan
TI  - Improving equity in kidney transplant allocation policies through a novel genetic 
      metric: The Matched Donor Potential.
PG  - 45-54
LID - S1600-6135(22)29280-6 [pii]
LID - 10.1016/j.ajt.2022.08.001 [doi]
AB  - The demand for donors' kidneys continues to increase amid a shortage of available 
      donors. Managing policies to thoughtfully allocate this scarce resource is a 
      complex process. Although human leukocyte antigen (HLA) matching has been shown 
      to prolong graft survival, its relative contribution to allocation schemes is 
      empirically compromised owing to competing priorities. We explored using a new 
      metric, Matched Donor Potential (MDP), to facilitate improved HLA matching while 
      promoting equity. We interrogated all active kidney waitlist patients (N = 164 
      427), their corresponding unacceptable antigen files, and all effective donors in 
      the Scientific Registry of Transplant Recipients (January 1, 2016-December 31, 
      2017). Cause-specific hazard functions were evaluated to assess the potential 
      impact of the MDP metric on deceased donor transplant access rates for all 
      candidates. Access was affected by ethnicity, blood group type, and calculated 
      Panel Reactive Antibody (cPRA). Importantly, we show that access to 
      transplantation is influenced by the patient's own HLA makeup regardless of their 
      ethnicity and by the HLA makeup of effective donors. The MDP metric demonstrates 
      a high association with access to transplantation. Adjusting Cox models to 
      include this new metric resulted in improved access to kidney transplantation for 
      waitlist candidates of minority heritage while significantly promoting HLA 
      matching. Thus, the MDP metric accounts for balanced, equitable organ allocation 
      algorithms.
CI  - Copyright (c) 2022 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Tambur, Anat R
AU  - Tambur AR
AD  - Comprehensive Transplant Center, Department of Surgery, Feinberg School of 
      Medicine, Northwestern University, Chicago, Illinois, USA. Electronic address: 
      a-tambur@northwestern.edu.
FAU - Audry, Benoit
AU  - Audry B
AD  - Agence de la Biomedecine, Paris, France.
FAU - Glotz, Denis
AU  - Glotz D
AD  - Department of Nephrology and Transplantation, Hopital Saint-Louis, Paris, France.
FAU - Jacquelinet, Christian
AU  - Jacquelinet C
AD  - Agence de la Biomedecine, Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20230111
PL  - United States
TA  - Am J Transplant
JT  - American journal of transplantation : official journal of the American Society of 
      Transplantation and the American Society of Transplant Surgeons
JID - 100968638
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Humans
MH  - *Kidney Transplantation/methods
MH  - *Tissue and Organ Procurement
MH  - Tissue Donors
MH  - Kidney
MH  - HLA Antigens
MH  - Graft Survival
MH  - Histocompatibility Testing/methods
OTO - NOTNLM
OT  - Scientific Registry for Transplant Recipients (SRTR)
OT  - clinical research/practice
OT  - deceased donor transplantation
OT  - histocompatibility
OT  - kidney transplantation/nephrology
OT  - major histocompatibility complex (MHC)
OT  - organ allocation
OT  - registry/registry analysis
OT  - waitlist management
EDAT- 2023/01/26 06:00
MHDA- 2023/01/28 06:00
CRDT- 2023/01/25 09:12
PHST- 2022/03/29 00:00 [received]
PHST- 2022/07/12 00:00 [revised]
PHST- 2022/08/21 00:00 [accepted]
PHST- 2023/01/25 09:12 [entrez]
PHST- 2023/01/26 06:00 [pubmed]
PHST- 2023/01/28 06:00 [medline]
AID - S1600-6135(22)29280-6 [pii]
AID - 10.1016/j.ajt.2022.08.001 [doi]
PST - ppublish
SO  - Am J Transplant. 2023 Jan;23(1):45-54. doi: 10.1016/j.ajt.2022.08.001. Epub 2023 
      Jan 11.