Takemoto S, Terasaki P I
Clin Transpl. 1994:451-66.
Cadaver-donor transplants performed before 1987 that had survived for more than 7 years despite having all 6-A,B,DR antigens mismatched were used to develop a list of permissible mismatches. When these permissible mismatches were applied to an entirely different set of cadaver-donor grafts performed after 1987, patients with permissible mismatches had a higher graft survival than those with an equivalent number of immunogenic mismatches. In addition, a new list of permissible mismatches was produced from living-donor transplants which survived for more than one year despite having mismatches. When this list made from living-donor transplants was checked against cadaver-donor transplants, patients with one-permissible-A,B,DR mismatch had a projected 10-year graft survival equivalent to that of zero-A,B,DR mismatched transplants. Patients with one immunogenic mismatch had a significantly lower graft survival. Patients with only permissible mismatches had a higher graft survival than those with immunogenic mismatches and equivalent to patients with one immunogenic mismatch. It was projected that the percentage of patients who can benefit from a zero-A,B,DR mismatched transplant by national sharing can be doubled if one permissible-mismatched grafts are also shared. Even in local pools, the use of permissible-mismatched grafts can be projected to improve 10-year graft survival rates from the current 41% to 52%.
1987年以前进行的尸体供体移植，尽管6个A、B、DR抗原均不匹配，但存活超过7年，以此来制定允许不匹配的清单。当将这些允许的不匹配应用于1987年以后进行的另一组完全不同的尸体供体移植时，具有允许不匹配的患者的移植物存活率高于具有同等数量免疫原性不匹配的患者。此外，从活体供体移植中得出了一份新的允许不匹配清单，这些移植尽管存在不匹配但存活超过一年。当将这份从活体供体移植得出的清单与尸体供体移植进行对照时，具有一个允许的A、B、DR不匹配的患者预计10年移植物存活率与零个A、B、DR不匹配的移植相当。具有一个免疫原性不匹配的患者的移植物存活率显著较低。仅具有允许不匹配的患者的移植物存活率高于具有免疫原性不匹配的患者，且与具有一个免疫原性不匹配的患者相当。据预测，如果也共享一个允许不匹配的移植物，通过全国共享能够受益于零个A、B、DR不匹配移植的患者比例可以翻倍。即使在本地库中，使用允许不匹配的移植物预计也能将10年移植物存活率从目前的41%提高到52%。
