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A new HLA allocation procedure of kidneys from deceased donors in the current era of immunosuppression

par Broeders, Emine Nilufer ;Racapé, Judith ;Hamade, Anwar ;Massart, Annick ;Hoang, Anh Dung ;Mikhalski, Dimitri ;Le Moine, Alain ;Vereerstraeten, Pierre
Référence Transplantation proceedings, 47, 2, page (267-274)
Publication Publié, 2015-03

Article révisé par les pairs

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Résumé :

Introduction It has recently been proposed to replace the current Eurotransplant kidney allocation based primarily on mismatches (MM) at the 3 HLA loci by a simpler system based on full HLA-DR compatibility. The present study analyzes this system in the current era of immunosuppression. Methods From 1999 to 2012, 723 renal grafts were performed on 586 patients who were treated with a calcineurin inhibitor, mycophenolate mofetil, and in most cases antilymphocyte globulins. Four groups of HLA MM were compared: (A) A+B 2-4/DR 1-2 MM (n = 397), (B) A+B 2-4 MM/DR 0 MM (n = 106), (C) A+B 0-1 MM/DR 1-2 MM (n = 138), and (D) A+B 0-1/DR 0 MM (n = 82). Results Acute rejection episodes were less frequent during the first post-transplantation year in group D than in the other groups (P =.018). Patient survival was lower in group A than in the other groups (P =.008). Immunologic graft survival was higher in group D than in the other groups in univariate (P =.015) and multivariate analyses (P =.033; 96.4% vs 90.1% at 10 years). Conclusions In the current era of immunosuppression, allocation of kidneys from deceased donors could be performed primarily according to full DR compatibility then to the best A+B matching, affording excellent graft outcome to most recipients.