全国共享的 HLA 配型相符患者肾移植标准变化的影响

Hata Y, Cecka J M, Takemoto S, Ozawa M, Cho Y W, Terasaki P I

UCLA Tissue Typing Laboratory, Department of Surgery, University of California, Los Angeles 90095, USA.

Transplantation. 1998 Jan 27;65(2):208-12. doi: 10.1097/00007890-199801270-00011.

BACKGROUND

Nine years ago, a prospective trial began in all U.S. transplant centers to determine whether the results of renal transplantation would improve with the nationwide shipment of kidneys from cadaveric donors to HLA-matched patients. Since then, the stringency of criteria for HLA matching have been liberalized twice, from sharing only those kidneys that matched at all six HLA-A, -B, -DR antigens, to sharing phenotypically HLA-matched kidneys, and most recently to sharing zero HLA-mismatched kidneys.

METHODS

Data reported to the United Network for Organ Sharing Scientific Renal Transplant Registry from October 1987 to December 1996 were analyzed to examine the transplant results of nationally shared HLA-matched kidneys and the effects of changes to the HLA matching criteria on graft survival and the distribution of HLA-matched kidneys.

RESULTS

The overall 1-year graft survival rate of 5102 HLA-matched transplants was 88% compared with 81% for 58,207 recipients of kidneys with at least one HLA mismatch (P < 0.001). HLA-matched kidneys had a projected 12-year graft half-life, 50% higher than the 8-year half-life of mismatched grafts (P < 0.01). After the first change in the match criteria in August 1990, 1365 phenotypically matched kidneys with fewer than six HLA antigens identified had an 89% 1-year graft survival rate compared with 84% for 466 six antigen-matched kidneys transplanted before the change. After March 1995, 1067 zero HLA-mismatched kidneys that were not phenotypically identical nor six antigen matched, had a 1-year graft survival rate of 88%. Graft survival has not decreased as a result of these changes in the criteria for national sharing, despite an increase in the percentage of matched transplants from 2.5% during the six antigen-match era to 15.5% during the zero antigen-mismatch era.

CONCLUSIONS

Changes to the United Network for Organ Sharing policy for national sharing of HLA-matched kidneys have increased the number of patients, and especially minority patients, who can benefit by receiving a well-matched graft without compromising the high graft survival rates provided by an HLA-matched kidney.

背景

九年前，美国所有移植中心开展了一项前瞻性试验，以确定将尸体供者的肾脏全国范围内配型至HLA匹配的患者，肾移植结果是否会得到改善。从那时起，HLA配型标准的严格程度已放宽了两次，从仅共享在所有六个HLA - A、- B、- DR抗原上都匹配的肾脏，到共享表型HLA匹配的肾脏，最近又到共享零HLA错配的肾脏。

方法

分析1987年10月至1996年12月向器官共享联合网络科学肾脏移植登记处报告的数据，以检查全国共享的HLA匹配肾脏的移植结果，以及HLA配型标准变化对移植物存活和HLA匹配肾脏分配的影响。

结果

5102例HLA匹配移植的总体1年移植物存活率为88%，而58207例至少有一个HLA错配的肾脏受者的1年移植物存活率为81%（P < 0.001）。HLA匹配的肾脏预计移植物半衰期为12年，比错配移植物的8年半衰期高50%（P < 0.01）。1990年8月首次改变配型标准后，1365例表型匹配、识别出的HLA抗原少于六个的肾脏，1年移植物存活率为89%，而改变前移植的466例六个抗原匹配的肾脏的1年移植物存活率为84%。1995年3月之后，1067例既不是表型相同也不是六个抗原匹配的零HLA错配肾脏，1年移植物存活率为88%。尽管全国共享标准的这些变化使匹配移植的比例从六个抗原匹配时代的2.5%增加到零抗原错配时代的15.5%，但移植物存活率并未因这些变化而降低。