PMID- 9381546
OWN - NLM
STAT- MEDLINE
DCOM- 19971107
LR  - 20231103
IS  - 0041-1337 (Print)
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 64
IP  - 7
DP  - 1997 Oct 15
TI  - HLA and cross-reactive antigen group matching for cadaver kidney allocation.
PG  - 983-91
AB  - BACKGROUND: Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) 
      compatibility scoring arguably has had little effect on overall survival while 
      prejudicing the transplant candidacy of African-American and other hard to match 
      populations. Consequently, matching has been proposed of deduced amino acid 
      residues of the individual HLA molecules shared by cross-reactive antigen groups 
      (CREGs). We have examined the circumstances under which compatibility with either 
      method impacted graft survival. METHODS: Using Cox proportional hazards 
      regression modeling, we studied the relationship between levels of conventional 
      HLA mismatch and other donor and recipient factors on primary cadaver kidney 
      survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in 
      the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 
      (n=31,291). The results were compared with those obtained by the matching of 
      amino acid residues that identified CREG-compatible cases with as many as four 
      (but not five and six) HLA mismatches. RESULTS: With more than one HLA mismatch 
      (> 85% of patients in both series), most of the survival advantage of a zero 
      mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not 
      Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched 
      recipients (35.3%) had better graft survival than the remaining 64.7%, who were 
      CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA 
      incompatibility tiers. Better graft survival with tacrolimus was observed in both 
      the Pittsburgh and UNOS series. CONCLUSIONS: Obligatory national sharing of 
      cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The 
      potential value of CREG matching observed in the one-HLA-mismatched recipients of 
      the UNOS (but not the Pittsburgh) experience deserves further study.
FAU - Starzl, T E
AU  - Starzl TE
AD  - The Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical 
      Center, Pennsylvania 15213, USA.
FAU - Eliasziw, M
AU  - Eliasziw M
FAU - Gjertson, D
AU  - Gjertson D
FAU - Terasaki, P I
AU  - Terasaki PI
FAU - Fung, J J
AU  - Fung JJ
FAU - Trucco, M
AU  - Trucco M
FAU - Martell, J
AU  - Martell J
FAU - McMichael, J
AU  - McMichael J
FAU - Scantlebury, V
AU  - Scantlebury V
FAU - Shapiro, R
AU  - Shapiro R
FAU - Donner, A
AU  - Donner A
LA  - eng
GR  - R01 DK029961-19/DK/NIDDK NIH HHS/United States
GR  - DK 29961/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
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
MH  - Adolescent
MH  - Adult
MH  - Black People/genetics
MH  - Cadaver
MH  - Child
MH  - Child, Preschool
MH  - Cross Reactions
MH  - Female
MH  - Graft Survival/immunology/*physiology
MH  - HLA-A Antigens/immunology
MH  - HLA-B Antigens/immunology
MH  - HLA-DR Antigens/immunology
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Pennsylvania
MH  - Proportional Hazards Models
MH  - Registries
MH  - Retrospective Studies
MH  - Time Factors
MH  - *Tissue Donors
MH  - Tissue and Organ Procurement/*methods/organization & administration
MH  - White People
PMC - PMC2967288
MID - NIHMS241750
EDAT- 1997/11/05 00:00
MHDA- 1997/11/05 00:01
PMCR- 2010/11/01
CRDT- 1997/11/05 00:00
PHST- 1997/11/05 00:00 [pubmed]
PHST- 1997/11/05 00:01 [medline]
PHST- 1997/11/05 00:00 [entrez]
PHST- 2010/11/01 00:00 [pmc-release]
AID - 10.1097/00007890-199710150-00009 [doi]
PST - ppublish
SO  - Transplantation. 1997 Oct 15;64(7):983-91. doi: 10.1097/00007890-199710150-00009.