Ziemann, Malte, Hessler, Nicole, Koenig, Inke R., Lachmann, Nils, Dick, Andrea, Ditt, Vanessa, Budde, Klemens, Reinke, Petra ORCID: 0000-0003-0771-4375, Eisenberger, Ute, Suwelack, Barbara, Klein, Thomas, Westhoff, Timm H. ORCID: 0000-0001-5797-834X, Arns, Wolfgang, Ivens, Katrin, Habicht, Antje, Renders, Lutz, Stippel, Dirk ORCID: 0000-0002-1107-0907, Boes, Dominik, Sommer, Florian, Goerg, Siegfried, Nitschke, Martin, Feldkamp, Thorsten, Heinemann, Falko M. and Kelsch, Reinhard (2017). Unacceptable human leucocyte antigens for organ offers in the era of organ shortage: influence on waiting time before kidney transplantation. Nephrol. Dial. Transplant., 32 (5). S. 880 - 890. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2385

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Abstract

Background. The assignment of human leucocyte antigens (HLAs) against which antibodies are detected as unacceptable antigens (UAGs) avoids allocation of HLA-incompatible allografts. There is uncertainty as to what extent UAGs decrease the probability of receiving a kidney offer. Methods. Kidney transplantations in 3264 patients on the waiting lists of six German transplant centres were evaluated for a period of at least 2 years. The proportion of excluded offers due to UAGs was calculated as virtual panel-reactive antibodies (vPRAs). Results. In the common Eurotransplant Kidney Allocation Scheme, the transplant probability was unaffected by vPRAs in exploratory univariate analyses. In the multivariable model, a 1% increase in vPRA values was outweighed by an additional waiting time of 2.5 weeks. The model was confirmed using an external validation cohort of 1521 patients from seven centres. If only patients with standard risk were considered (e.g. no simultaneous transplantation of other organs), only 1.3 weeks additional waiting time was needed. In the Eurotransplant Senior Program, patients with vPRA values >50% had a strongly reduced transplant probability in the unadjusted analyses. In the multivariable model, a 1% increase in vPRA values was outweighed by an additional waiting time of 5 weeks. Conclusions: This study demonstrates that the assignment of UAGs decreases the transplant probability in both main Eurotransplant allocation programs because of insufficient compensatory mechanisms. At present, for immunized patients, a prolonged waiting time has to be weighed against the increased immunologic risk due to donor-specific antibodies not assigned as UAGs.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Ziemann, MalteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hessler, NicoleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koenig, Inke R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lachmann, NilsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dick, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ditt, VanessaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Budde, KlemensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reinke, PetraUNSPECIFIEDorcid.org/0000-0003-0771-4375UNSPECIFIED
Eisenberger, UteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Suwelack, BarbaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klein, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Westhoff, Timm H.UNSPECIFIEDorcid.org/0000-0001-5797-834XUNSPECIFIED
Arns, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ivens, KatrinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Habicht, AntjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Renders, LutzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stippel, DirkUNSPECIFIEDorcid.org/0000-0002-1107-0907UNSPECIFIED
Boes, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sommer, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goerg, SiegfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nitschke, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Feldkamp, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heinemann, Falko M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kelsch, ReinhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-233438
DOI: 10.1093/ndt/gfw462
Journal or Publication Title: Nephrol. Dial. Transplant.
Volume: 32
Number: 5
Page Range: S. 880 - 890
Date: 2017
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2385
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
IMPLEMENTATION; RECIPIENTS; PROGRAM; PRAMultiple languages
Transplantation; Urology & NephrologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/23343

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