Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients
Heidt, Sebastiaan; Haasnoot, Geert W.; Witvliet, Marian D.; van der Linden-van Oevelen, Marissa J.H.; Kamburova, Elena G.; Wisse, Bram W.; Joosten, Irma; Allebes, Wil A.; van der Meer, Arnold; Hilbrands, Luuk B.; Baas, Marije C.; Spierings, Eric; Hack, Cornelis E.; van Reekum, Franka E.; van Zuilen, Arjan D.; Verhaar, Marianne C.; Bots, Michiel L.; Drop, Adriaan C.A.D.; Plaisier, Loes; Seelen, Marc A.J.; Sanders, Jan Stephan; Hepkema, Bouke G.; Lambeck, Annechien J.A.; Bungener, Laura B.; Roozendaal, Caroline; Tilanus, Marcel G.J.; Voorter, Christina E.; Wieten, Lotte; van Duijnhoven, Elly M.; Gelens, Marielle A.C.J.; Christiaans, Maarten H.L.; van Ittersum, Frans J.; Nurmohamed, Shaikh A.; Lardy, Neubury M.; Swelsen, Wendy; van der Pant, Karlijn A.M.I.; van der Weerd, Neelke C.; ten Berge, Ineke J.M.; Bemelman, Frederike J.; Hoitsma, Andries; van der Boog, Paul J.M.; de Fijter, Johan W.; Betjes, Michiel G.H.; Otten, Henny G.; Roelen, Dave L.; Claas, Frans H.J.
(2019) American Journal of Transplantation, volume 19, issue 10, pp. 2926 - 2933
(Article)
Abstract
Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM
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patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.
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Keywords: alloantibody, clinical research/practice, histocompatibility, immunogenetics, kidney transplantation/nephrology, major histocompatibility complex (MHC), rejection, nephrology, practice, clinical research, kidney transplantation, Transplantation, Pharmacology (medical), Immunology and Allergy, Journal Article, Research Support, Non-U.S. Gov't
ISSN: 1600-6135
Publisher: Blackwell Publishing Asia Pty Ltd
Note: Funding Information: The PROCARE study was supported by research funding from Dutch Kidney Foundation project code CP12.23 (risk assessment of kidney graft failure by HLA antibody profiling). The authors thank the Eurotransplant staff and all Eurotransplant HLA laboratories and transplantation centers for their constructive collaboration and participation in the AM program. Publisher Copyright: © 2019 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
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