A SERVICE
OF 
With National
Sharing, More Matched Kidneys and Better Results
BOSTON: October 15, 2000 · by TNN Medical Reporter Virginia
Baskerville
- Better results of kidney transplantation occur when the donor and
recipient are HLA-matched, giving credence to the idea that organs should be
allocated nationally rather than locally.
"A superior graft outcome with
little increase in the duration of cold ischemia justifies national sharing of
HLA-matched kidney transplants," Steven K. Takemoto, PhD, of the University of
California at Los Angeles reported on October 12 in The New England
Journal of Medicine (2000;343:1078-1084).
In reaching their
findings, the authors studied the rates of rejection and graft survival for
7614 HLA-matched and 81,364 HLA-mismatched cadaveric kidney transplants
reported to the United Network for Organ Sharing (UNOS) Scientific Renal
Transplant Registry between October 1987 -- when UNOS established a national
kidney-sharing program -- and September 1999. The estimated 10-year rate of
graft survival was 52% for the matched transplants and 37% for the mismatched
transplants.
The authors also looked at a subgroup of 3562 pairs of
kidneys in which one kidney went to a matched recipient and the other to a
mismatched recipient. In this group, the matched transplants had higher rates
of survival, a lower incidence of rejection episodes, and a lower risk of loss
as a result of rejection.
The results with HLA matching justified the
slightly longer cold ischemia time that occurred when kidneys were shipped to
matched recipients. The mean duration of cold ischemia time was 23 hours for
matched transplants and 22 hours for mismatched transplants.
The authors
concluded that "it is likely that the percentage of HLA-matched transplants
could be increased by extending the organ-sharing network to include Canada,
since many Canadian cities are close to those in the United
States."
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