Unintended Consequences of the New National Kidney Allocation Policy in the United States

A. R. Tambur*, K. M K Haarberg, J. J. Friedewald, J. R. Leventhal, M. F. Cusick, A. Jaramillo, M. M. Abecassis, B. Kaplan

*Corresponding author for this work

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

The new national Kidney Allocation System of the Organ Procurement and Transplantation Network (OPTN), effective as of December 4, 2014, was designed to improve the chances of transplanting the most highly sensitized patients on the waitlist, those with calculated panel reactive antibody values of 98%, 99% and 100%. Recently, it was suggested that these highly sensitized patients will experience inequitable access, given the reported high prevalence of antibodies to HLA-DP, and the fact that only about 1/3 of deceased donors are typed for HLA-DP antigens. Here we report that 320/2948 flow cytometric crossmatches performed for the Northwestern transplant program over the past 28 months were positive solely due to HLA-DP donor-specific antibodies (11%; 16.5% of patients with HLA antibodies - sensitized patients). We further show that 58/207 (12%) HLA-DR serologically matched donor-recipient pairs had a positive B cell flow crossmatch due to donor-specific HLA class II antibodies, and 2/34 (6%) serologic zero-HLA-A-B-DR mismatch had a positive flow crossmatch due to HLA-DSA. We therefore provide information regarding the necessity and importance of complete donor HLA typing including both chains of the HLA-DP antigen (encoded by HLA-DPA1 and HLA-DPB1) at the time of organ offer. The authors demonstrate that donor-specific HLA-DP antibodies are the sole reason for up to 16% of positive deceased-donor flow-cytometric crossmatch results.

Original languageEnglish (US)
Pages (from-to)2465-2469
Number of pages5
JournalAmerican Journal of Transplantation
Volume15
Issue number9
DOIs
StatePublished - Sep 1 2015

Keywords

  • Organ Procurement and Transplantation Network (OPTN)
  • ethics and public policy
  • kidney transplantation/nephrology
  • organ allocation
  • organ procurement and allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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