HLA-A, -B, and -DR zero-mismatched kidneys shipped to the University of Wisconsin, Madison, 1993-2006: superior graft survival despite longer preservation time.
HLA-A, -B, and -DR zero-mismatched kidneys shipped to the University of Wisconsin, Madison, 1993-2006: superior graft survival despite longer preservation time.
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HLA-A、-B 和 -DR 零错配肾脏于 1993-2006 年运往威斯康星大学麦迪逊分校：尽管保存时间较长，但移植物存活率较高。
DOI：
10.1097/tp.0b013e3181e49b9f
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发表时间：
2010
期刊：
影响因子：
6.2
通讯作者：
D'Alessandro,Anthony
中科院分区：
文献类型：
--
作者：
Burlingham,WilliamJ;MunozdelRio,Alejandro;Lorentzen,David;Sollinger,HansW;Pirsch,JohnD;Jankowska-Gan,Ewa;D'Alessandro,Anthony
背景：为了确定联合器官共享网络授权的人类白细胞抗原（HLA）-A/-B/-DR 0-不匹配（0 MM）肾脏共享计划对单个中心的影响，我们分析了1993年至2006年期间264例0 MM远端供者的肾移植结果，随访至2007年1月31日。我们比较了这些结果与同时移植的肾脏从HLA超过0 MM本地供体和运超过0 MM肾脏从“payback”donors.Results.Despite一个显着较长的保存时间，我们发现一个11%的增加8年移植存活率（63%比52%; P< 0.003）的0 MM运与本地采购，> 0 MM供体肾。非致敏受者（< 20%群体反应性抗体; 68% vs. 55%; P< 0.0005）8年时0 MM移植肾的移植物存活率明显更高，但致敏受者（≥ 20%群体反应性抗体）的移植物存活率则不高，后者表现出早期（2年）但短暂的获益。接受HLA-A、-B和-DR 0 MM运送肾脏的获益仍然很强，且具有统计学显著性（与当地相比，移植物丢失的相对风险为0.71; P< 0.02）在考克斯比例风险分析中调整了22个潜在混杂变量。结论：最近联合器官共享网络政策的变化限制了对致敏和儿科受者强制共享0 MM肾脏，给予当地器官采购组织更大的器官分配灵活性。然而，对非致敏患者的生存益处是真实的和持久的，并且将丧失。
Background.To determine the impact at a single center of the United Network for Organ Sharing-mandated sharing program for human leukocyte antigen (HLA)-A/-B/-DR 0-mismatched (0MM) kidneys, we analyzed the results of 264 kidney transplants from 0MM distant donors between 1993 and 2006, with a follow-up through January 31, 2007. We compared these results with that of concurrent kidneys transplanted from HLA more than 0MM local donors and with shipped more than 0MM kidneys from “payback” donors.Results.Despite a significantly longer preservation time, we found an 11% increase in 8-year graft survival (63% vs. 52%; P< 0.003) of 0MM shipped versus locally procured,> 0MM donor kidneys. Graft survival of 0MM shipped kidneys at 8 years was significantly better in nonsensitized (< 20% panel reactive antibodies; 68% vs. 55%; P< 0.0005) but not in sensitized (≥ 20% panel reactive antibodies) recipients, who showed an early (2 years) but short-lived benefit. The benefit of receiving a HLA-A,-B, and-DR 0MM shipped kidney remained strong and statistically significant (0.71 relative risk of graft loss vs. local; P< 0.02) when adjusted for 22 potentially confounding variables in a Cox proportional hazards analysis.Conclusions.The recent change in United Network for Organ Sharing policy restricting mandated sharing of 0MM kidneys to sensitized and pediatric recipients will give greater flexibility to the local organ procurement organization in allocating organs. However, the survival benefit to nonsensitized patients is real and long lasting and will be lost.