Allocation of deceased donor kidneys: A review of international practices

Lee, Darren Hui Kwong; Kanellis, John; Mulley, William R.

doi:10.1111/nep.13548

Cited by 40 publications

(38 citation statements)

References 36 publications

(44 reference statements)

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“…On the cohort level, this resulted in an increase of graft survival of this cohort and a lower chance of HLA‐immunization after transplantation. However, we also noticed that specific patient groups would suffer from a longer waiting time, indicating that any adjustment of the allocation system could not be beneficial for specific patient groups as has been appreciated in other studies on allocation . For this reason, we will design adjustments of the allocation system that result in overall improvement of outcome, with minimization of inequalities in waiting time.…”

Section: Discussionmentioning

confidence: 94%

Results and reflections from the PROfiling Consortium on Antibody Repertoire and Effector functions in kidney transplantation: A mini‐review

Kamburova

Hoitsma

Claas

et al. 2019

HLA

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Kidney transplantation is the best treatment option for patients with end‐stage renal disease (ESRD). The waiting time for a deceased donor kidney in the Netherlands is approximately 3 years. Mortality among patients on the waiting list is high. The aim of the PROCARE consortium (PROfiling Consortium on Antibody Repertoire and Effector functions) was to decrease the waiting time by providing a matching algorithm yielding a prolonged graft survival and less HLA‐immunization compared with the currently used Eurotransplant Kidney allocation system. In this study, 6097 kidney transplants carried out between January 1995 and December 2005 were re‐examined with modern laboratory techniques and insights that were not available during that time period. In this way, we could identify potential new parameters that can be used to improve the matching algorithm and prolong graft survival. All eight University Medical Centers in the Netherlands participated in this multicenter study. To improve the matching algorithm, we used as central hypothesis that the combined presence of class‐I and ‐II single‐antigen bead (SAB)‐defined donor‐specific HLA antibodies (DSA) prior to transplantation, non‐HLA antibodies, the number of B‐ and/or T‐cell epitopes recognized on donor HLA, and specific polymorphisms in effector mechanisms of IgG were associated with an increased risk for graft failure. The purpose of this article is to relate the results obtained from the PROCARE consortium study to other studies published in recent years. The clinical relevance of SAB‐defined DSA, complement‐fixing DSA, non‐HLA antibodies, and the effector functions of (non)‐HLA‐antibodies will be discussed.

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Section: Discussionmentioning

confidence: 94%

Results and reflections from the PROfiling Consortium on Antibody Repertoire and Effector functions in kidney transplantation: A mini‐review

Kamburova

Hoitsma

Claas

et al. 2019

HLA

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“…Transplant patients and deceased donors often differ in ethnicity especially in an ethnically diverse population such as British Columbia 23 , raising concern that allelic diversity may create an inequality barrier by increasing waitlist times for ethnic minorities with rare genotypes, diminishing the enthusiasm for stringent HLA matching for deceased donor transplantation in Canada and other locations of high population diversity [24][25][26] . We observed differences in allele carrier rates between deceased donors and patients in this study, while both patient sub-groups, prior to or post-transplantation serving as internal controls, showed tight correlation with each other (r = 0.992).…”

Section: Discussionmentioning

confidence: 99%

“…But graft success or economic costs are not the sole arbiters of policy and the utility donated organs must be balanced by equality of access to them 24 . Matching at the eplet level may more closely approximate this latter goal than the simple use of allele compatibility, though accommodation must still be considered for recipients with uncommon eplets of high biological importance.…”

Section: Discussionmentioning

confidence: 99%

Population Frequencies Determined by Next-generation Sequencing Provide Strategies for Prospective HLA Epitope Matching for Transplantation

Tran¹,

Günther²,

Sherwood³

et al. 2020

Preprint

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Compatibility for human leukocyte antigen (HLA) genes between transplant donors and recipients improves graft survival but prospective matching is rarely performed due to the vast heterogeneity of this gene complex. To reduce complexity, we have combined next-generation sequencing and in silico mapping to determine population frequencies and matching probabilities of 150 antibody-binding eplets across all 11 classical HLA genes in 2000 ethnically heterogeneous renal patients and donors. We show that eplets are more common and more uniformly distributed between donors and recipients than the respective HLA isoforms. Simulation of targeted eplet matching shows that a high degree of overall compatibility, and perfect identity at the clinically important HLA class II loci, can be obtained within a patient waiting list of approximately 250 subjects. Internal epitope-based allocation is thus feasible for most major renal transplant programs, while regional or national sharing may be required for other solid organs.

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“…Additionally, tissue typing is used in deceased donor kidney allocation where good HLA‐matching of a waiting list patient to a donor frequently gives them priority to be allocated a kidney from that donor. This is performed to increase the likelihood that the kidney will last longer than if it was allocated to a recipient with a poorer match to the donor …”

Section: Human Leukocyte Antigensmentioning

confidence: 99%

Tissue typing for kidney transplantation for the general nephrologist

et al. 2019

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This review explains the complexity and shortcomings of serological and molecular human leukocyte antigens (HLA) typing, which are critical in the assessment of immunological risks for potential kidney transplant candidates. Consequently, the determination of HLA structure using molecular typing has enabled a more accurate assessment of HLA compatibility between donors and recipients. ABSTRACT:Tissue typing is the process by which an individual's human leukocyte antigens (HLA) are determined. In transplantation, this vital process allows the immunologic or rejection risk of a donor-recipient pairing to be assessed through reviewing their HLA matching and whether any anti-HLA antibodies present in recipient serum are donor specific. Tissue typing has increased in sophistication over time which has allowed a deeper appreciation of the antigenically important parts of HLA and increased the complexity of determining immunologic risk.

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Allocation of deceased donor kidneys: A review of international practices

Cited by 40 publications

References 36 publications

Results and reflections from the PROfiling Consortium on Antibody Repertoire and Effector functions in kidney transplantation: A mini‐review

Results and reflections from the PROfiling Consortium on Antibody Repertoire and Effector functions in kidney transplantation: A mini‐review

Population Frequencies Determined by Next-generation Sequencing Provide Strategies for Prospective HLA Epitope Matching for Transplantation

Tissue typing for kidney transplantation for the general nephrologist

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