Comparison of blood group versus HLA-dependent transplantation and its influence on donor kidney survival

Gillich, Markus S.; Heimbach, D.; Schoeneich, G.; Müller, Stefan; Klehr, H. U.

doi:10.1093/ndt/17.5.884

Cited by 11 publications

(15 citation statements)

References 6 publications

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“…In the UNOS study, the association between HLA matching and transplant outcomes appear to be related to HLA‐DR mismatches within the first‐yr post‐transplant and related to HLA‐AB mismatches beyond the first‐yr post‐transplant. However, the importance of HLA matching on graft survival in the era of more potent immunosuppression remains inconsistent . Analysis of the Collaborative Transplant Study data demonstrated that the importance of HLA matching on graft outcomes remained strong during the two decades of 1985–1994 and 1995–2004, suggesting that HLA mismatches continued to significantly affect graft outcomes even in the era of modern immunosuppression .…”

Section: Discussionmentioning

confidence: 99%

Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients

Lim

Chadban

Clayton

et al. 2012

Clinical Transplantation

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Human leukocyte antigen (HLA) mismatches have been shown to adversely affect renal allograft outcomes and remain an important component of the allocation of deceased donor (DD) kidneys. The ongoing importance of HLA mismatches on transplant outcomes in the era of more potent immunosuppression remains debatable. Using Australia and New Zealand Dialysis and Transplant Registry, live and DD renal transplant recipients between 1998 and 2009 were examined. The association between the number of HLA mismatches and HLA-loci mismatches and outcomes were examined. Of the 8036 renal transplant recipients, 59% had between 2 and 4 HLA mismatches. Compared with 0 HLA mismatch, increasing HLA mismatches were associated with a higher risk of graft failure and patient death in the adjusted models. HLA mismatches were associated with an incremental risk of rejection although the relative risk was higher for live donor kidney transplants. Increasing HLA-AB and HLA-DR mismatches were associated with a greater risk of acute rejection, graft failure, death-censored graft failure, and/or death. There was no consistent association between initial immunosuppressive regimen and outcomes. Our results corroborate and extend the previous registry analyses demonstrating that HLA mismatches are associated with poorer transplant outcomes independent of immunosuppression and transplant era.

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Section: Discussionmentioning

confidence: 99%

Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients

Lim

Chadban

Clayton

et al. 2012

Clinical Transplantation

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“…The 2006 re-appraisal led to reduced priority being attached to HLA matching in the UK, and allowed consideration of other criteria [7]. The resulting guidelines [8] suggested more priority should be given to long waiters and paediatric and younger adult recipients.…”

Section: Introductionmentioning

confidence: 99%

Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

et al. 2012

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BackgroundPolicies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue.MethodsDiscrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life.ResultsResponses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches.ConclusionsOur econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority.

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“…An ethical tension is thus created between two principles: promoting equity (giving everyone a chance to have access to transplantation), or maximizing efficacy (allocating organs to those recipients who would benefit the most). The criteria developed for the allocation of organs, which differ from one country to the other [5,6], attempt to reconcile this ethical tension. With the goal, always, of focusing on the best use of the resource, in order to increase the efficacy of renal transplantation recent scientific research is now focused on developing an approach based on personalized medicine.…”

Section: Introductionmentioning

confidence: 99%

The use of personalized medicine for patient selection for renal transplantation: Physicians' views on the clinical and ethical implications

et al. 2010

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BackgroundThe overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.MethodsThe qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.ResultsThe results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.ConclusionsThe participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.

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Comparison of blood group versus HLA-dependent transplantation and its influence on donor kidney survival

Abstract: The results show that it is possible to provide patients with a locally allocated kidney graft that enables good function after a short waiting period. This procedure avoids long cold ischaemia time and long waiting periods.

Cited by 11 publications

References 6 publications

Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients

Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in renal transplant recipients

Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

The use of personalized medicine for patient selection for renal transplantation: Physicians' views on the clinical and ethical implications

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