Figure 817

The role of human leukocyte antigen (HLA) matching in the United States in whites (A) and blacks (B). Recent large registry analyses of the role for HLA matching in renal transplantation consistently have shown a stepwise decrease in long-term graft survival rates with increasing antigen mismatches. Based on these results the United Network of Organ Sharing (UNOS) incorporated the level of HLA match into its algorithm used nationally for kidney allocation. The UNOS initially determined that transplantations for which all six HLA-A, -B, and -DR antigens matched in the donor and recipient should be performed. Each cadaveric donor type was compared by a computer search with the HLA types of all patients awaiting kidney transplantation. When a patient with six antigen matches was identified in an ABO-compatible recipient, the kidney was offered for that patient, and if accepted by the transplantation center, was shipped for transplantation. (Normally, kidneys from a patient with blood type O are allocated only to patients with type O blood, except in the case of patients with six antigen matches.) The UNOS policy regarding mandatory sharing of HLA-matched kidneys has been liberalized twice. The first time was in 1990 to include pheno-typically matched pairs with fewer than six antigens. The policy was changed for a second time in 1995 to include zero-mismatched pairs in which the donor could have fewer antigens than the recipient, provided none were mismatched. (Adapted from Cecka [5]; with permission.)

Serology Molecular

(antibody defined) (Low Intermediate High resolution)

0 0

Post a comment