Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

HLA and cross-reactive antigen group matching for cadaver kidney allocation

Starzl, TE and Eliasziw, M and Gjertson, D and Terasaki, PI and Fung, JJ and Trucco, M and Martell, J and Mcmichael, J and Scantlebury, V and Shapiro, R and Donner, A (1997) HLA and cross-reactive antigen group matching for cadaver kidney allocation. Transplantation, 64 (7). 983 - 991. ISSN 0041-1337

[img]
Preview
PDF
Accepted Version
Available under License : See the attached license file.

Download (2MB) | Preview
[img] Plain Text (licence)
Available under License : See the attached license file.

Download (1kB)

Abstract

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.


Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Starzl, TEtes11@pitt.eduTES11
Eliasziw, M
Gjertson, D
Terasaki, PI
Fung, JJ
Trucco, M
Martell, J
Mcmichael, J
Scantlebury, V
Shapiro, R
Donner, A
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 15 October 1997
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 64
Number: 7
Page Range: 983 - 991
DOI or Unique Handle: 10.1097/00007890-199710150-00009
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062127133, Starzl CV No. 1991
Date Deposited: 08 Apr 2010 17:34
Last Modified: 13 Oct 2017 22:59
URI: http://d-scholarship.pitt.edu/id/eprint/5377

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com


Actions (login required)

View Item View Item