Prospective trial of a predictive algorithm to transplant cadaver kidneys into highly sensitized patients.
Prospective trial of a predictive algorithm to transplant cadaver kidneys into highly sensitized patients.
复制标题
将尸体肾脏移植到高度敏感患者体内的预测算法的前瞻性试验。
DOI：
10.1097/00007890-200204270-00015
复制
发表时间：
2002
期刊：
影响因子：
6.2
通讯作者：
Byrne,James
中科院分区：
文献类型：
--
作者：
Thompson,JohnS;Thacker,Leroy;Byrne,James
背景：致敏患者的移植难度与群体反应性抗体（PRA）滴度成比例增加。由于最终交叉配型阳性的可能性很高，这些患者通常被排除在前瞻性移植之外，除非HLA-A、-B、-DR不匹配。为了解决这个问题，我们开发了一种计算机算法，称为肯塔基州抗体检测系统（KATS），预测I类HLA抗原，这将是“不可接受的”和“可接受的”收件人。本文介绍了一项在自愿参与的中心中进行的前瞻性试验的结果，这些中心同意根据KATS预测的PRA超过40%的患者共享肾脏。方法将每例患者的3种抗体筛查结果与面板中细胞的HLA表型进行2× 2表比较，计算卡方和相关系数统计。私人，广泛的，和公共的抗原被确定和可接受的和不可接受的抗原的列表被输入到UNOS计算机中的KATS共享algorithm.Results.Of所有418例患者符合纳入/排除标准，提交的最大的单一组是黑人非西班牙裔女性。患者的平均PRA为72%。1997年3月8日，通过KATS分配进行了第一次移植。从那时到2000年7月31日的最后一次移植，参与中心提供了145个肾脏，进行了48次移植。在列出的不接受报价或不将共享肾脏移植到其预期受体的许多原因中，只有两个是因为阳性T细胞交叉配型，六个是因为阳性B细胞交叉配型。与东南器官采购基金会中在研究期间接受移植的所有其他高PRA患者相比，他们更可能是非白人，与私人HLA-A，B和DR抗原匹配不佳，并且比其他组等待更长的时间。虽然有一个较高的发病率延迟移植功能，有没有显着差异冷缺血，排斥事件，或患者或移植survival.Conclusions.我们得出结论，KATS，或其他一些系统，以前瞻性地确定一个列表的可接受和不可接受的HLA抗原，可以提高获得高度致敏的患者成功的肾移植。
Background.The difficulty of transplanting sensitized patients increases proportionally to the panel reactive antibody (PRA) titer. Because of the high likelihood of a positive final crossmatch, these patients are often excluded from a prospective transplant unless there is a 0 HLA-A,-B,-DR mismatch. To address this problem, we developed a computerized algorithm, termed the Kentucky Antibody Testing System (KATS), that predicts class I HLA antigens that would be both “unacceptable” and “acceptable” to the recipient. This report describes the results of a prospective trial among voluntarily participating centers that agreed to share kidneys based on the KATS predictions for patients whose PRA exceeded 40%.Methods.The results of three antibody screens on each patient were compared with the HLA phenotypes of the cells in the panel in 2× 2 tables with calculation of chi-square and correlation coefficient statistics. Private, broad, and public antigens were identified and a list of acceptable and unacceptable antigens were entered into the UNOS computer for each patient listed in the KATS sharing algorithm.Results.Of the total 418 patients meeting the inclusion/exclusion criteria, the largest single group submitted was Black-not-of-Hispanic-origin females. The mean PRA of the patients was 72%. The first transplant via KATS allocation was performed on March 8, 1997. Between that time and the last transplant on July 31, 2000, 145 kidneys were offered to the participating centers and 48 transplants were performed. Of the many reasons listed for not accepting an offer or not transplanting the shared kidney into its intended recipient, only two occurred because of a positive T cell crossmatch and six because of a positive B cell crossmatch. As compared to all other high PRA patients within Southeastern Organ Procurement Foundation who were transplanted during the study period, they were more likely to be non-Caucasian, to be less well matched for private HLA-A, B, and DR antigens, and to have waited for a longer time than the other groups. Although there was a higher incidence of delayed graft function, there was no significant difference in cold ischemia, rejection episodes, or patient or graft survival.Conclusions.We conclude that KATS, or some other system to prospectively identify a list of acceptable and unacceptable HLA antigens, could improve the access of highly sensitized patients to a successful kidney transplant.