Transplanting the highly sensitized patient: The emory algorithm
Transplanting the highly sensitized patient: The emory algorithm
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DOI：
10.1111/j.1600-6143.2006.01521.x
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发表时间：
2006-10-01
影响因子：
8.8
通讯作者：
Gebel, H. M.
中科院分区：
文献类型：
--
作者：
Bray, R. A.;Nolen, J. D. L.;Gebel, H. M.
对HLA抗原致敏的肾移植患者占UNOS等待名单的近三分之一，并接受14%的死亡供体（DD）移植，这一比例是未致敏患者的一半。在1999年至2003年期间，我们进行了492例成人肾移植，其中120例患者（约25%）的群体反应性抗体（PRA）> 30%，近一半（n = 58）的PRA> 80%。我们的方法是基于高分辨率的固相HLA抗体分析，以确定I/II类抗体和“虚拟交叉配型”，以预测兼容的供体/受体组合。如果捐赠者拥有不可接受的抗原，则接受者将被排除在器官共享联合网络的匹配运行之外。因此，当致敏患者出现在匹配运行中时，他们具有阴性最终交叉配血的高概率。在这里，我们描述了我们使用这种方法的5年经验。在未致敏（n = 272）、中度致敏（PRA <30%，n = 100）和高度致敏（PRA> 30%; n = 120）患者中，5年移植物存活率为66%至70%，等于全国平均移植物存活率（65.7%）。这种方法（Emory算法）的应用提供了一种逻辑和系统的方法，以改善致敏患者获得DD器官的机会，并促进更公平地分配给等待肾移植的高度弱势患者群体。
Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (similar to 25%) had a panel reactive antibody (PRA) of > 30%, with nearly half (n = 58) having a PRA of > 80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (> 30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.