#53
THE IMPACT OF THE RELATIVE WEIGHT OF HLA -B AND DR MATCHING WITHIN A NATIONAL ALLOCATION SYSTEM ON LONG TERM RENAL ALLOGRAFT SURVIVAL AND FUNCTION.
Moshe Shabtai MD 1, Eitan Mor MD 2, Esther L. Shabtai MsC 3, Ron Lowenthal MD 1 and Amram Ayalon MD 1. 1 Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel ; 2 Transplantation, Rabin Medical Center, Petach Tiqva, Israel and 3 Statistical Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel .
The availability of highly efficacious immune suppressive agents, together with the hightened awareness to social parameters in organ sharing organizatios, have steadily reduced the relative weight given to HLA matching in organ allocation algorithms. The aim of this study was to measure the impact of the relative weight of HLA -B and -DR matching within a 4 parameter score system employed by a national organ allocation organization primarily on duration of good graft function and long term graft survival . The computerized records of 978 transplants were reviewed and the relative weight of each of the 4 parameters(waiting time, HLA-B, and DR mismatches, PRA and age) scored within the allocation algorithm was computed. HLA relative weight was clustered in 3 groups (low 0%, mid 1-60%, high>60% of total score) and correlated with the duration of excellent or very good graft function and with overall graft survival . A significant difference (p=0.0048) was seen in graft survival between high and low relative weight of HLA. The duration of excellent graft function (creatinine<1.2 mg/%) in the higher wight group was significantly longer (68
34 mo) compared to 5935 mo in the lower weight group (p=0.05). Linear regression showed the same difference between lower and higher relative weight groups.
It appears that albeit the devaluation of HLA matching in organ allocation it still has a significant impact on duration of excellent graft function as well as survival.