Transplanting the highly sensitized patient : The emory algorithm

摘要: Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% deceased donor (DD) transplants, a rate half that unsensitized patients. Between 1999 2003, we performed 492 adult renal transplants from DD; 120 (approximately 25%) had panel reactive antibody (PRA) >30%, with (n = 58) having PRA >80%. Our approach is based upon high-resolution solid-phase analysis identify class I/II antibodies 'virtual crossmatch' predict compatible donor/recipient combinations. Recipients are excluded United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when appear on run, they have high probability negative final crossmatch. Here, describe our 5-year experience this approach. Five-year graft survival ranged 66% 70% among 272), moderately (PRA 30% PRA; n 120) patients, equal average national (65.7%). The application (the Emory Algorithm) provides logical systematic improve access DD organs promote more equitable allocation highly disadvantaged group awaiting transplantation.