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      Renal Transplantation of Highly Sensitised Patients via Prioritised Renal Allocation Programs

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          Abstract

          Background: Highly sensitised renal transplant candidates (HSP) have a reduced chance of receiving a transplant. In Eurotransplant (ET), two special allocation programs have been made available for such patients: the Highly Immunised Tray (HIT) program and the Acceptable Mismatch program (AM), albeit with different inclusion and exclusion criteria (HIT, current PRA% ≧85%; AM, current and/or historical PRA% ≧85%). When a suitable kidney is available for a patient, included in these special programs, the kidney is mandatory offered. In contrast, in the point score system of the standard ET kidney allocation procedure (ETKAS), HSP (PRA ≧85%) only get a marginal bonus according to their current sensitisation. It was tested whether the allocation priority of the two special allocation programs is justified from the perspective of transplant outcome. Methods: The post- transplant outcomes of recent consecutive cohorts of AM, HIT and HSP-ETKAS transplants were compared. The end points were initial graft function, rejection episodes during the first three months post-transplant, and 1-year kidney graft outcome. Results: Between January 1, 1997 and June 30, 1998, 101 HSP received a kidney-only transplant: 29 via AM, 39 via HIT and 33 via ETKAS. HLA-A,B,DR matching was more favourable in the AM and HIT allocation groups and their waiting times till transplantation were much shorter than those of the HSP-ETKAS allocation group. The incidence of initial graft non-function was similar among the three HSP allocation groups, averaging 50%. Recovery of the initial non-function was more likely for AM and HIT transplants. No difference was present with regard to the percentage of patients who experienced at least one rejection episode during the first three months post-transplant, averaging 43%. However, the AM group had less severe and/or less recurrent rejection episodes. The 1-year kidney graft survival, censored for death with functional graft, was 96% for AM, 82% for HIT and 75% for HSP-ETKAS transplants (p = 0.04). Conclusions: The two special allocation programs for HSP do yield adequate results and offer a shorter waiting time, compared to the standard kidney allocation procedure. The AM approach might be preferred because of the smoother post-transplant management and the better graft survival, keeping the HIT approach as a back up. Since the allocation priority is justified in view of efficiency, the renal transplant community should support the incorporation of a special allocation program for HSP in their respective organ exchange program.

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          Association between specific HLA combinations and probability of kidney allograft loss: the taboo concept

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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            1660-8151
            2235-3186
            2002
            September 2002
            14 August 2002
            : 92
            : 1
            : 111-119
            Affiliations
            aEurotransplant International Foundation, and bEurotransplant Reference Laboratory, Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
            Article
            64480 Nephron 2002;92:111–119
            10.1159/000064480
            12187093
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 1, Tables: 3, References: 13, Pages: 9
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/64480
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