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Previous Volume 350:545-551 February 5, 2004 Number 6 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by van Rood, J. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

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.

Source Information

From the University of California at San Francisco, San Francisco (J.P.R.); the University of Michigan (R.A.W., V.B.A.) and the University Renal Research and Education Association (J.L.B.-G., S.H.R., P.J.H., F.K.P.) — both in Ann Arbor; the Medical College of Georgia, Augusta (J.J.W.); and the State University of New York Health Science Center at Brooklyn, Brooklyn (D.A.D.).

Address reprint requests to Dr. Roberts at the University of California at San Francisco, 505 Parnassus Ave., Rm. M896, San Francisco, CA 94143-0780, or at robertsj{at}surgery.ucsf.edu.

Full Text of this Article

Related Letters:

Changing the Priority for HLA Matching in Kidney Transplantation
Thorsby E., Pfeffer P. F., Spital A., Wendt K. J., Kamoun M., Sellers M. T., Roberts J. P., Wolfe R. A., Port F. K.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:2095-2096, May 13, 2004. Correspondence

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