Premium
Transplanting the Highly Sensitized Patient: The Emory Algorithm
Author(s) -
Bray R. A.,
Nolen J. D. L.,
Larsen C.,
Pearson T.,
Newell K. A.,
Kokko K.,
Guasch A.,
Tso P.,
Mendel J. B.,
Gebel H. M.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01521.x
Subject(s) - medicine , united network for organ sharing , transplantation , panel reactive antibody , human leukocyte antigen , antigen , algorithm , antibody , urology , surgery , kidney transplantation , immunology , computer science , liver transplantation
Renal transplant patients sensitized to HLA antigens comprise nearly one‐third of the UNOS wait‐list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (∼25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high‐resolution solid‐phase HLA antibody analysis to identify class I/II antibodies and a ‘virtual crossmatch’ to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5‐year experience with this approach. Five‐year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.