Equitable allocation of HLA-compatible kidneys for local pools and for minorities.
Equitable allocation of HLA-compatible kidneys for local pools and for minorities.
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为当地库和少数群体公平分配 HLA 相容肾脏。
DOI：
10.1056/nejm199409223311202
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发表时间：
1994
期刊：
影响因子：
--
通讯作者：
Cecka,JM
中科院分区：
文献类型：
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作者：
Takemoto,S;Terasaki,PI;Gjertson,DW;Cecka,JM
背景在美国，由于过分强调HLA配型，尸体肾脏的分配方法被批评为对少数民族不公平。我们评估了一种新的HLA匹配的方法，可能会减轻这个问题。MethodsWe使用的数据从器官共享联合网络（UNOS）肾移植登记处评估和预测尸体肾移植的结果。一种基于HLA-A和B分子的10个关键氨基酸残基和有限数量的HLA-DR类型的相容性的HLA匹配方法，使用目前在国家等待名单和在洛杉矶和伯明翰，亚拉巴马的等待名单上的患者的HLA类型进行评估。或DR错配的移植患者中，有66%的患者发生了HLA-A、B或DR错配，相比之下，有两个以上HLA-A、B或DR错配的移植患者中，有39%的患者发生了HLA-A、B或DR错配。通过本地共享，43%的患者可以完全匹配，他们的10年移植存活率预计为50%。当允许一个HLA-DR错配时，预计10年移植存活率为46%，67%的当地等待患者可以接受这种移植。即使在亚拉巴马，其中68%的患者在等待名单上是黑色的，48%的等待患者可以获得一个匹配的kidney.ConclusionsInserting两个新的HLA匹配类别到UNOS点系统的尸体肾脏分配将增加患者的数量，可以在当地的游泳池中找到匹配。
BackgroundThe methods used to allocate cadaveric kidneys in the United States have been criticized as being unfair to minorities because of an overemphasis on HLA matching. We evaluated a new HLA-matching method that might alleviate this problem.MethodsWe used data from the United Network for Organ Sharing (UNOS) Kidney Transplant Registry to evaluate and project the outcome of cadaveric kidney transplantation. An HLA-matching method based on compatibility at 10 key amino acid residues of HLA-A and B molecules and a limited number of HLA-DR types was evaluated with use of the HLA types of the patients currently on the national waiting list and waiting lists in Los Angeles and Birmingham, Alabama.ResultsWith national kidney sharing, the projected 10-year rate of graft survival for transplants in which there were no HLA-A, B, or DR mismatches was 66 percent, as compared with 39 percent for transplants with more than two HLA-A, B, or DR mismatches. With local sharing, 43 percent of patients could be fully matched, and they had a projected 10-year graft-survival rate of 50 percent. When one HLA-DR mismatch was allowed, the projected 10-year graft survival was 46 percent, and 67 percent of patients waiting locally could receive such grafts. Even in Alabama, where 68 percent of the patients on the waiting list are black, 48 percent of waiting patients could obtain a matched kidney.ConclusionsInserting two new HLA-matching categories into the UNOS point system for cadaveric kidney allocation would increase the number of patients for whom matches could be found in local pools.