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- Title
Sharing kidneys across donor-service area boundaries with sensitized candidates can be influenced by HLA C.
- Authors
Bryan, Christopher F.; Luger, Alan M.; Smith, John L.; Warady, Bradley A.; Wakefield, Mark; Schadde, Erik; Murillo, Daniel; Nelson, Paul W.
- Abstract
Bryan CF, Luger AM, Smith JL, Warady BA, Wakefield M, Schadde E, Murillo D, Nelson PW. Sharing kidneys across donor-service area boundaries with sensitized candidates can be influenced by HLA C. Clin Transplant 2010: 24: 56–61. © 2009 John Wiley & Sons A/S. The United Network for Organ Sharing (UNOS) implemented the virtual crossmatch system in UNet as a way to improve the likelihood of a negative crossmatch when kidneys are shared with HLA-sensitized candidates across donor service area (DSA) boundaries. The role of HLA C in that process is not universally appreciated. We recently experienced an unexpected positive flow T and B cell crossmatch for an imported, HLA zero-mismatched kidney because of donor-specific HLA C antibodies and transplanted it into the backup candidate. HLA C locus antigens were not typed by the OPO’s laboratory that sent the kidney so the UNet virtual crossmatch could not “strike” our candidate from the UNOS match run. HLA C locus typing data of donors for kidneys our DSA imported from other DSAs revealed that C typing was not performed in 23% (14/60) and was discrepant with our molecular type for 10% (6/60) and was concordant in 67% (40/60) of cases. The rate of positive donor-specific crossmatches was higher (83%) for HLA C discrepantly typed donors than for concordantly typed donors (44%). Sensitization for HLA C (42%) is less frequent than for A (80%) or B (83%) locus antigens but the immunogenicity of C locus antigens in patients who make C locus antibodies is equivalent in black and white patients. Finally, the transplant rate of imported kidneys into class I-sensitized candidates was 24%, and C locus-sensitized candidates comprised 55% of those transplanted.
- Subjects
KIDNEY transplantation; HLA histocompatibility antigens; T cells; B cells; IMMUNOGLOBULINS
- Publication
Clinical Transplantation, 2010, Vol 24, Issue 1, p56
- ISSN
0902-0063
- Publication type
Article
- DOI
10.1111/j.1399-0012.2009.01167.x