Tardif G N, McCalmon R T
Immunological Associates of Denver, Colorado 80206, USA.
Clin Transplant. 1996 Dec;10(6 Pt 2):594-7.
The SEOPF high-grade match (HGM) algorithm for sharing kidneys was designed to increase utilization of kidneys for excellent HLA matches, decrease sharing for poor HLA matches, and improve the chances for highly sensitized patients to receive a kidney transplant through the use of ROP crossmatch trays. All retrieved kidneys from participating centers were offered to the system to be shared for high-grade HLA matches after six-antigen match obligations were satisfied with UNOS. Kidneys were shared according to HLA matches in the following priority: 1) 0-ABDR mismatch six - Antigen Matches. 2) 0-AB mismatch PRA > 40%, ROP tray negative crossmatch. 3) 0-BDR mismatch PRA > 40%, ROP tray negative crossmatch. 4) 0-BDR mismatch PRA < 40%. All patients with PRA's > 40% must be represented on the ROP tray to be considered for a shared kidney. Preliminary ROP tray crossmatch results must have been known for these patients in order to access the system. Here we report results of 126 shared kidneys using the HGM algorithm from January 1994 to September 1995. HLA typing concordance between the initial typing of cadaver donors by the donor center and repeat typing by recipient center was 94.7%. There were six (5.3%) typing discrepancies: HLA-A, no typing discrepancies; HLA-B, 2 (1.8%) typing discrepancies; and HLA-DR, 4 (3.5%) discrepancies. A total of 34 of 126 (27%) kidneys were shared for patients with high grade HLA matches, PRA's > 40% and a negative ROP tray. Twenty-eight of 34 (82.4%) shared kidneys were final crossmatch negative and transplanted into the intended recipient. Six of 34 (17.6%) shared kidneys were transplanted into backup recipients. All six of the intended recipients had positive final crossmatches using enhanced crossmatch procedures, such as antiglobulin and flow cytometry. In conclusion, the HLA concordance rate for shared kidneys within SEOPF was 94.7%. Kidney sharing using the HGM algorithm was very effective in transplanting highly sensitized patients when good HLA matching was combined with a negative ROP tray result.
用于肾脏分配的SEOPF高级匹配（HGM）算法旨在提高优质HLA匹配的肾脏利用率，减少劣质HLA匹配的分配，并通过使用ROP交叉配型板来增加高致敏患者接受肾脏移植的机会。在与器官共享联合网络（UNOS）完成六抗原匹配义务后，参与中心获取的所有肾脏都将提供给系统，用于优质HLA匹配的分配。肾脏根据HLA匹配情况按以下优先级分配：1）0-ABDR错配六抗原匹配。2）0-AB错配，PRA>40%，ROP板阴性交叉配型。3）0-BDR错配，PRA>40%，ROP板阴性交叉配型。4）0-BDR错配，PRA<40%。所有PRA>40%的患者必须在ROP板上有记录，才能考虑分配共享肾脏。这些患者必须已知初步的ROP板交叉配型结果，才能进入系统。在此，我们报告1994年1月至1995年9月使用HGM算法分配的126个共享肾脏的结果。供体中心对尸体供体的初始分型与受体中心的重复分型之间的HLA分型一致性为94.7%。有6例（5.3%）分型差异：HLA-A无分型差异；HLA-B有2例（1.8%）分型差异；HLA-DR有4例（3.5%）差异。126个肾脏中有34个（27%）分配给了HLA匹配优质、PRA>40%且ROP板阴性的患者。34个共享肾脏中有28个（82.4%）最终交叉配型为阴性，并移植给了预定受体。34个共享肾脏中有6个（17.6%）移植给了备用受体。所有6名预定受体使用抗球蛋白和流式细胞术等增强交叉配型程序后最终交叉配型均为阳性。总之，SEOPF内共享肾脏的HLA一致性率为94.7%。当良好的HLA匹配与阴性ROP板结果相结合时，使用HGM算法进行肾脏分配在移植高致敏患者方面非常有效。
