对已故供体肾移植受者中HLA交叉反应组匹配对移植物存活情况的评估。

Lazda V A, Mozes M F

Gift of Hope Organ & Tissue Donor Network, Elmhurst, Illinois 60126-1520, USA.

Transplant Proc. 2005 Mar;37(2):661-3. doi: 10.1016/j.transproceed.2004.12.110.

Since September 20, 1999, our organ procurement organization (OPO) serving an ethnically diverse local distribution area has allocated kidneys using a cross-reactive group (CREG)-based variance. This variance awards 7 points for 0-CREG,0-DR mismatches and 6 points for 0-A,B mismatches in addition to points given for waiting time (3) and panel-reactive antibodies (PRA) > or = 80% (3). Previously, we have shown that awarding points for 0-CREG,0-DR mismatches in kidney allocation improves the access to HLA-matched transplants for racial groups, especially for the black race. In this study, we evaluated if there are outcome benefits as well. One- and 3-year uncensored graft survival data and analyses for the influence of HLA mismatching on graft outcome in black and nonblack recipients were provided by Scientific Registry of Transplant Recipients (SRTR). Overall, 1-year graft survival was 87.4% and not significantly different for blacks (86.1%, n = 467) vs nonblacks (88.8%, n = 730); 3-year graft survival was 74.6% and significantly lower P = .0001 for blacks (68.5%, n = 480) vs nonblacks (78.4%, n = 765). No significant advantage was observed for either the black or nonblack recipients in any of the HLA-mismatched categories, including the 0-CREG,0-DR mismatch group. An HLA matching effect also was not seen when data were stratified for patients nonsensitized (PRA < or = 10%) and sensitized (PRA > 10%) at the time of transplantation, except for the improved graft survival in sensitized nonblack recipients of 0- A,B,DR-mismatched grafts. Of the patients who lost their grafts and returned to the waiting list for retransplantation, the 0-A,B,DR mismatched were the least sensitized group (6%, n = 16), and there was a trend for less sensitization in the 0-CREG,0-DR-mismatched group (33%, n = 9), compared to those with other HLA mismatches (68%, n = 137). Thus, based on 1-year and 3-year follow-up data, there are no apparent graft outcome benefits for either CREG matching or conventional HLA matching in our service area, except for sensitized nonblack recipients receiving 0-A,B,DR-mismatched grafts. Such benefits may become more apparent with longer follow-up.

自1999年9月20日起，我们服务于一个种族多元化本地配送区域的器官获取组织（OPO）一直采用基于交叉反应组（CREG）的差异分配肾脏。这种差异分配除了给予等待时间（3分）和群体反应性抗体（PRA）≥80%（3分）的分数外，对于0-CREG、0-DR错配给予7分，对于0-A、B错配给予6分。此前，我们已经表明，在肾脏分配中给予0-CREG、0-DR错配分数可改善种族群体获得HLA匹配移植的机会，尤其是黑人种族。在本研究中，我们还评估了是否存在结局益处。移植受者科学注册系统（SRTR）提供了1年和3年未删失的移植物存活数据以及关于HLA错配对黑人和非黑人受者移植物结局影响的分析。总体而言，1年移植物存活率为87.4%，黑人（86.1%，n = 467）与非黑人（88.8%，n = 730）之间无显著差异；3年移植物存活率为74.6%，黑人（68.5%，n = 480）与非黑人（78.4%，n = 765）相比显著更低（P = .0001）。在任何HLA错配类别中，包括0-CREG、0-DR错配组，黑人和非黑人受者均未观察到显著优势。当对移植时未致敏（PRA≤10%）和致敏（PRA＞10%）的患者数据进行分层时，也未发现HLA匹配效应，不过在0-A、B、DR错配移植物的致敏非黑人受者中移植物存活率有所提高。在失去移植物并返回等待名单进行再次移植的患者中，0-A、B、DR错配组是致敏程度最低的组（6%，n = 16），与其他HLA错配组（68%，n = 137）相比，0-CREG、0-DR错配组有致敏程度较低的趋势（33%，n = 9）。因此，基于1年和3年的随访数据，在我们的服务区域，除了接受0-A、B、DR错配移植物的致敏非黑人受者外，CREG匹配或传统HLA匹配均未显示出明显的移植物结局益处。随着随访时间延长，这种益处可能会更加明显。