HLA compatibility assessment and management of highly sensitized patients under the new kidney allocation system (KAS): A 2016 status report from twelve HLA laboratories across the U.S.

Kamoun, Malek; Phelan, D.; Noreen, Harriet; Marcus, Nalaja; Klingman, L.; Gebel, Howard M.

doi:10.1016/j.humimm.2016.10.023

Cited by 15 publications

(6 citation statements)

References 18 publications

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“…Next, there are several factors that can affect the accuracy of CPRA as the metric of a candidate’s level of sensitization. The criteria utilized for designating UA-HLA vary between HLA laboratories, 47 and as such CPRA values could underestimate a candidate’s level of sensitization at transplant centers with high thresholds. Likewise, we focused on HLA-A, -C, -B, -DR, and -DQ, and did not investigate the role of the HLA-DP locus.…”

Section: Discussionmentioning

confidence: 99%

HLA Homozygosity and Likelihood of Sensitization in Kidney Transplant Candidates

Rushakoff

Gragert

Pando

et al. 2022

Transplantation Direct

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Background. Homozygosity for HLAs has been associated with adverse outcomes after viral infection as well as pregnancy-induced HLA sensitization. We sought to assess the relationship between HLA locus homozygosity and the level of HLA antibody sensitization. Methods. We measured sensitization using the calculated panel reactive antibody value for a large cohort of 147 461 patients added to the US OPTN/United Network for Organ Sharing kidney transplant waitlist between December 2014 and December 2019. We used multinomial logistic modeling to compare 62 510 sensitized patients to 84 955 unsensitized controls. Results. We found that the number of homozygous HLA loci was strongly associated with the level of sensitization. Within mildly, highly, or extremely sensitized candidates, women displayed a higher relative abundance of HLA homozygosity at multiple HLA loci as compared with men, with attenuation of this effect in Black candidates. In a multivariable logistic model, the number of homozygous HLA loci interacted with female sex but not with other factors associated with sensitization, including recipient ethnicity and a history of prior kidney transplant. Conclusions. This study shows that HLA homozygosity is an innate genetic factor that affects the likelihood of HLA sensitization. Further research is needed to identify the immunologic mechanisms that underlie this observation.

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Section: Discussionmentioning

confidence: 99%

HLA Homozygosity and Likelihood of Sensitization in Kidney Transplant Candidates

Rushakoff

Gragert

Pando

et al. 2022

Transplantation Direct

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“…However, as CPRA is a rounded integer, within the 100% designation, the probability of matching varies according to the unrounded value 20 . When to call an HLA as unacceptable for a given patient (at what MFI value of a HLA antibody in the SAB assay should that HLA be considered unacceptable) is left to the discretion of individual transplant program and is a reflection of their willingness to assume the risks associated with anti-HLA antibodies 21 .…”

Section: What Is Calculated Panel Reactive Antibodies (Cpra)?mentioning

confidence: 99%

Principles of Virtual Crossmatch Testing for Kidney Transplantation

Bhaskaran

Heidt

Muthukumar

2022

Kidney International Reports

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“…highly sensitized patients receive additional priority for access to transplantation given their inherent disadvantage toward identifying a viable donor [33]. As another example, former living donors are highly prioritized for access to transplantation based on their prior contribution to the end-organ population [34].…”

Section: Key Pointsmentioning

confidence: 99%

Assessing the outcome of organ allocation: choosing metrics

Schold

2019

Current Opinion in Organ Transplantation

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Purpose of reviewOrgan allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. As with any policy change, rigorous evaluation of the impact of changes is important. Recent findingsThis manuscript discusses metrics to consider to evaluate the impact of organ allocation policy that may be monitored on an ongoing basis including examples of research evaluating current policies. Potential metrics to evaluate allocation policy include the effectiveness, efficiency, equity, costs, donor rates, and transparency associated with the system. SummaryUltimately, policies will often need to adapt to secular changes in donor and patient characteristics, clinical and technological advances, and overarching healthcare polices. Providing objective empirical evaluation of the impact of policies is a critical component for assessing quality of the allocation system and informing the effect of changes. The foundation of organ transplantation is built upon public trust and the dependence on the gift of donor organs, as such the importance of the most appropriate organ allocation policies cannot be overstated.

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HLA compatibility assessment and management of highly sensitized patients under the new kidney allocation system (KAS): A 2016 status report from twelve HLA laboratories across the U.S.

Cited by 15 publications

References 18 publications

HLA Homozygosity and Likelihood of Sensitization in Kidney Transplant Candidates

HLA Homozygosity and Likelihood of Sensitization in Kidney Transplant Candidates

Principles of Virtual Crossmatch Testing for Kidney Transplantation

Assessing the outcome of organ allocation: choosing metrics

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