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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 3  |  Page : 346-348
Organ Sharing in Saudi Arabia: A Proposal


Immunopathology Laboratory (1122), Dept. of Pathology & Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

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How to cite this article:
Hajeer AH. Organ Sharing in Saudi Arabia: A Proposal. Saudi J Kidney Dis Transpl 2007;18:346-8

How to cite this URL:
Hajeer AH. Organ Sharing in Saudi Arabia: A Proposal. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2019 Aug 24];18:346-8. Available from: http://www.sjkdt.org/text.asp?2007/18/3/346/33749
Currently, deceased organ allocation in Saudi Arabia is done through a rotation system. Each of the centers involved will receive organs from deceased persons by turn. When a center receives a kidney, it selects a group of patients who are ABO compatible and cross matches them. Based on the patient's health, time on waiting list, and other factors (HLA matching is not one of these factors), the organ(s) will be allocated. So far, there are no written guidelines or a scoring system that can be used as a standard of practice in deceased organ allocation.

Matching of HLA antigens between donors and recipients improves the outcome of kidney transplantation. [1] Matching provides the greatest advantage when the donor and the recipient have no (zero) antigens mismatched or matching is identical at all six HLA loci.

Data from the United Network for Organ Sharing (UNOS) show that patients who are highly sensitized to HLA antigens have limited access to kidney transplantation. [2] Highly sensitized patients are predominantly females and gain their sensitized state through pregnancy, blood transfusions or from previous transplants that have been rejected. [2]

There are many strategies currently used to overcome sensitization in patients awaiting renal transplantation. Methods to reduce preformed antibodies have targeted both the removal of existing antibodies and preventing their subsequent formation. These strategies include plasmapheresis, immunoadsorption, and treatment with intravenous immunoglobulin. [3],[4],[5]

HLA matching in renal transplantation remains one of the most important factors governing outcome of the graft. Opelz et al. [6] studied the influence of HLA compatibility on organ transplant survival in more than 150,000 recipients transplanted from 1987 to 1997 at transplant centers participating in the Collaborative Transplant Study. One of their significant results was that among first-deceased organ transplant recipients with an antibody reactivity >50%, the difference in graft survival at 5 years between patients with zero or six mismatches reached 30%. [6]

Results from the United States suggest that HLA mismatching in renal transplant has big economic implications. Average Medicare payments for renal transplant recipients in the 3 years post-transplantation increased from US$60,000 per patient for fully HLA-matched kidneys to US$80,000 for kidneys with six HLA mismatches between donor and recipient. [7]

Data from a prospective study on a predictive program for highly sensitized patients suggested that identifying a list of acceptable and unacceptable HLA antigens could improve the access of highly sensitized patients to a successful renal transplant. [8]

Thus, many studies worldwide have demonstrated the significant effect of HLA matching on the outcome of graft survival in renal transplantation, especially in highly sensitized patients. Several programs worldwide have modified their allocation of deceased grafts (kidney) in order to integrate HLA matching as part of their selection criteria. [9],[10],[11],[12],[13]


   Proposal Top


In the context of the data presented earlier, we propose establishing a central database of highly sensitized patients in Saudi Arabia. The database should include the following: updated patient list from all participating centers: patients' HLA type, panel reactive antibodies (PRA) (historical and updated), and a list of unacceptable antigens. The unacceptable antigens are defined as the HLA antigens that reacted positive in the patient's PRA or previously transplanted kidney HLA type. Once a kidney is received by the center, the procedure will be carried out as usual; and once the donor HLA type is known, it will be sent to the central database to compare with the highly sensitized patient HLA types. If a patient is found zero mismatched at HLA-A, -B and -DR, and there is no unacceptable antigen(s) in the donor HLA type, priority is given to that patient. The kidney will be dispatched to the center where the patient is prepared for cross matching and surgery.

 
   References Top

1.Takemoto SK, Terasaki PI, Gjertson DW, Cecka JM. Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation. N Engl J Med 2000;343:1078-84.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Jordan SC. Management of the highly HLA-sensitized patient. A novel role for intravenous gammaglobulin. Am J Transplant 2002;2:691-2.  Back to cited text no. 2    
3.Valentini RP, Nehlsen-Cannarella SL, Gruber SA, et al. Intravenous immunoglobulin, HLA allele typing and HLA Matchmaker facilitate successful transplan-tation in highly sensitized pediatric renal allograft recipients. Pediatr Transplant 2007;11:77-81  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Rahman T, Harper L. Plasmapheresis in nephrology: an update. Curr Opin Nephrol Hypertens 2006;15:603-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Lorenz M, Regele H, Schillinger M, et al. Peritransplant immunoadsorption: a strategy enabling transplantation in highly sensitized crossmatch-positive cadaveric kidney allograft recipients. Transplan-tation 2005;79:696-701.  Back to cited text no. 5    
6.Opelz G, Wujciak T, Dohler B, Scherer S, Mytilineos J. HLA compatibility and organ transplant survival. Collaborative Transplant Study. Rev Immunogenet 1999;1:334-42.  Back to cited text no. 6    
7.Schnitzler MA, Hollenbeak CS, Cohen DS, et al. The economic implications of HLA matching in cadaveric renal transplan-tation. N Engl J Med 1999;341:1440-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Thompson JS, Thacker L, Byrne J. Prospective trial of a predictive algorithm to transplant cadaver kidneys into highly sensitized patients. Transplantation 2002;73:1274-80.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.McCune TR, Blanton JW, Thacker LR 2nd, Adams PA. The high grade match kidney sharing algorithm of the South-Eastern Organ Procurement Foundation (SEOPF): altering recipient demographics through improved matching. Transplantation 1997;64:860-4.   Back to cited text no. 9    
10.Poli F, Scalamogna M, Cardillo M, Porta E, Sirchia G. An algorithm for cadaver kidney allocation based on a multivariate analysis of factors impacting on cadaver kidney graft survival and function. Transplant Int 2000;13 Suppl 1:S259-62.  Back to cited text no. 10    
11.Hata Y, Cecka JM, Takemoto S, Ozawa M, Cho YW, Terasaki PI. Effects of changes in the criteria for nationally shared kidney transplants for HLA-matched patients. Transplantation 1998;65:208-12.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Yuan Y, Gafni A, Russell JD, Ludwin D. Development of a central matching system for the allocation of cadaveric kidneys: a simulation of clinical effectiveness versus equity. Med Decis Making 1994;14:124-36.  Back to cited text no. 12  [PUBMED]  
13.Fuggle SV, Johnson RJ, Rudge CJ, Forsythe JL. Human leukocyte antigen and the allocation of kidneys from cadaver donors in the United Kingdom. Trans-plantation 2004;77:618-20.  Back to cited text no. 13    

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Correspondence Address:
Ali H Hajeer
Dept. of Pathology and Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426
Saudi Arabia
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PMID: 17679743

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