National Network Allows More Successful Kidney Transplants
"Kidney sharing for the purpose of achieving good HLA matches is much more accepted in central Europe than in the U.S., where it still is considered controversial," Gerhard Opelz, MD, a professor of immunology at the University of Heidelberg, Germany, tells WebMD. Opelz was not involved with the U.S. study but is coordinator of the Collaborative Transplant Study, which involves more than 300 transplant centers in 45 countries.
"Our international study shows that the results are very similar in all geographical regions of the world; it is just the perception of clinicians that differs," Opelz says. "Hopefully, this new paper will influence the policy-making body in the U.S."
Another finding of the new study was that HLA-matched kidneys given to black recipients who had high blood pressure lasted only half as long as they did in black recipients with other causes of kidney failure.
"This study shows that not even matched grafts work very well in blacks, especially those with [high blood pressure]. We need to work on improving outcome in this group," says Charles F. Shield, MD, who reviewed the study for WebMD. Shield is director of organ transplantation at Via Christi-St. Francis Hospital in Wichita, Kan.
People with unusual tissue types have more difficulty in getting a matched kidney. Only 3% of black patients in TheNew England Journal of Medicine study received a matched kidney, as most donors were white, and black patients tend to be more difficult to match for HLA markers.
"To add some justice to the system, we factor other things into the decision of who gets the kidney, such as waiting time. Children get higher priority," Cecka says. "Unfortunately, those that are on top of the list because they've been waiting the longest are often the worst candidates."
The National Allocation Program assigns a set number of points for each of the factors, then determines the best possible match, Cecka explains. Only 20% of donated kidneys find an acceptable HLA match, and the rest get transplanted locally.
The researchers note that age should be among the factors taken into consideration. Many kidneys are from older donors, which could fail prematurely in younger recipients, they say.