Monteiro F, Coria S A, Boni R, Pereira L A
São Paulo Organ Allocation System, Health Secretariat of São Paulo, São Paulo, Brazil.
Transplant Proc. 2009 Jan-Feb;41(1):93-4. doi: 10.1016/j.transproceed.2008.10.051.
In Brazil, organ transplantation has been regulated by a federal law since 1997. This law was created to guarantee equal access to treatment on a national scale. Deceased donor organ procurement and sharing are centralized and controlled by the Health Department of each state of the nation, following a regional allocation policy. In São Paulo, time on the waiting list was the main criterion adopted to allocate deceased donor kidneys up to January 1, 2002. After that, HLA mismatches (MM) were the main criterion. The aim of this study was to investigate the impact of HLA compatibility on graft survival among 3312 consecutive kidney recipients. The 2-year kidney graft survival rates were compared among recipients transplanted based on the waiting time policy and based on HLA MM. Better results were observed in the HLA MM group (78.1% vs 64.9%; P < .0001). Regarding kidney allocation based on HLA MM, recipients transplanted with 0 HLA-A, -B, or -DR MM showed significantly better 5-year survival rates than those with 1-2 or 3-4 or 5-6 HLA-A, -B, or -DR MM (70.36% vs 64.71% vs 58.07% vs 55.64%; P < .050). We concluded that HLA compatibility is a feasible criterion to allocate deceased donor kidneys in Brazil.
自1997年以来，巴西的器官移植一直受一项联邦法律监管。制定这项法律是为了在全国范围内保障平等的治疗机会。已故捐赠者器官的获取和分配由该国每个州的卫生部门集中管理，并遵循区域分配政策。在圣保罗，截至2002年1月1日，等待名单上的时间是分配已故捐赠者肾脏的主要标准。此后，人类白细胞抗原错配（MM）成为主要标准。本研究的目的是调查3312例连续肾脏受者中人类白细胞抗原相容性对移植物存活的影响。比较了根据等待时间政策和根据人类白细胞抗原错配进行移植的受者的2年肾脏移植物存活率。在人类白细胞抗原错配组中观察到了更好的结果（78.1%对64.9%；P <.0001）。关于基于人类白细胞抗原错配的肾脏分配，移植时人类白细胞抗原A、B或DR无错配的受者5年存活率显著高于有1 - 2个或3 - 4个或5 - 6个人类白细胞抗原A、B或DR错配的受者（70.36%对64.71%对58.07%对55.64%；P <.050）。我们得出结论，在巴西，人类白细胞抗原相容性是分配已故捐赠者肾脏的一个可行标准。
