The effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups
The effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups
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DOI：
10.1056/nejmoa025056
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发表时间：
2004-02-05
影响因子：
158.5
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Roberts, JP;Wolfe, RA;Port, FK
工作背景：在美国，HLA分型和患者在等待名单上花费的时间是用于分配尸体肾移植的主要标准。没有HLA-A、B和DR错配的候选人被给予最高优先级，其次是HLA-B和DR位点错配最少的候选人;这一政策导致白人的移植率高于非白人。我们假设，改变这种分配政策会影响移植物的存活率和种族之间的平衡transplantrecipient.Methods：我们估计肾移植的相对比率，根据种族导致从目前的分配政策和种族差异的HLA抗原谱，使用考克斯模型的时间从放置在等待名单上移植。另一个模型，也调整了HLA-B和DR抗原谱，估计肾移植的相对比率，如果这些抗原谱的分布在种族和民族群体之间是相同的。我们还研究了HLA配型对移植失败风险的影响，采用考克斯模型计算从首次移植到移植失败的时间。这两项分析的结果被用来估计移植和移植失败率的种族平衡的变化，这将导致消除HLA-B匹配或HLA-B和DR匹配作为分配优先级的手段。取消HLA-B匹配作为优先事项，同时保持HLA-DR匹配作为优先事项，将使白人的移植数量减少4.0%（一年内减少166例移植），而这将使非白人的移植数量增加6.3%，移植物丢失率增加2.0%。取消HLA-B匹配作为尸体肾脏分配的优先事项，可以通过增加非白人的移植数量来减少现有的种族不平衡，移植物丢失率仅略有增加。
Background: HLA typing and the time a patient has spent on the waiting list are the primary criteria used to allocate cadaveric kidneys for transplantation in the United States. Candidates with no HLA-A, B, and DR mismatches are given top priority, followed by candidates with the fewest mismatches at the HLA-B and DR loci; this policy contributes to a higher transplantation rate among whites than nonwhites. We hypothesized that changing this allocation policy would affect graft survival and the racial balance among transplant recipients.Methods: We estimated the relative rates of kidney transplantation according to race resulting from the current allocation policy and racial differences in HLA antigen profiles, using a Cox model for the time from placement on the waiting list to transplantation. Another model, also adjusted for HLA-B and DR antigen profiles, estimated the relative rates of kidney transplantation that would result if the distribution of these antigen profiles were identical among the racial and ethnic groups. We also investigated the effect of HLA matching on the risk of graft failure, using a Cox model for the time from the first transplantation to graft failure. The results of the two analyses were used to estimate the change in the racial balance of transplantation and graft-failure rates that would result from the elimination of HLA-B matching or HLA-B and DR matching as a means of assigning priority.Results: Eliminating the HLA-B matching as a priority while maintaining HLA-DR matching as a priority would decrease the number of transplantations among whites by 4.0 percent (166 fewer transplantations over a one-year period), whereas it would increase the number among nonwhites by 6.3 percent and increase the rate of graft loss by 2.0 percent.Conclusions: Removing HLA-B matching as a priority for the allocation of cadaveric kidneys could reduce the existing racial imbalance by increasing the number of transplantations among nonwhites, with only a small increase in the rate of graft loss.