United network for organ sharing
United network for organ sharing
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DOI：
10.1111/j.1600-6143.2004.00572.x
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发表时间：
2004-10-01
影响因子：
8.8
通讯作者：
Rohrer, RJ
中科院分区：
文献类型：
--
作者：
Delmonico, FL;Morrissey, PE;Rohrer, RJ
无论人类白细胞抗原（HLA）是否错配，活体供者的肾移植都能获得良好的结果。这一发展扩大了从无关的活体供体进行肾移植的机会。然而，超急性排斥反应的危险通常排除了将活体供体的肾移植给ABO血型或HLA抗体交叉配型反应不相容的潜在受体。器官共享联合网络（UNOS）的第一区域设计了一种替代肾移植系统，该系统可以在活体捐赠者之间同时交换（配对交换），或者将活体捐赠者/死者捐赠者交换给名单上等待的不相容的接受者（活体捐赠者/名单交换）。该区域交换系统获得了活体捐献的益处，避免了ABO或交叉配型不相容的风险，并为等待死亡供体肾脏的患者提供了额外的供体来源。尽管等待O型血肾脏的患者名单最初存在缺点，但由于每次配对交换移植都将患者从等待名单中删除，因此也避免了不相容的受体最终不得不进入名单。因此，这一办法也增加了名单上其余候选人获得已故捐赠肾脏的机会。
Kidney transplantation from live donors achieves an excellent outcome regardless of human leukocyte antigen (HLA) mismatch. This development has expanded the opportunity of kidney transplantation from unrelated live donors. Nevertheless, the hazard of hyperacute rejection has usually precluded the transplantation of a kidney from a live donor to a potential recipient who is incompatible by ABO blood type or HLA antibody crossmatch reactivity. Region 1 of the United Network for Organ Sharing (UNOS) has devised an alternative system of kidney transplantation that would enable either a simultaneous exchange between live donors (a paired exchange), or a live donor/deceased donor exchange to incompatible recipients who are waiting on the list (a live donor/list exchange). This Regional system of exchange has derived the benefit of live donation, avoided the risk of ABO or crossmatch incompatibility, and yielded an additional donor source for patients awaiting a deceased donor kidney. Despite the initial disadvantage to the list of patients awaiting an O blood type kidney, as every paired exchange transplant removes a patient from the waiting list, it also avoids the incompatible recipient from eventually having to go on the list. Thus, this approach also increases access to deceased donor kidneys for the remaining candidates on the list.