hrvatski

BENEFITS OF 11-LOCI REAL-TIME POLYMERASE CHAIN REACTION HLA TYPING IN KIDNEY ALLOCATION PROCESS

GOALS In the deceased donor kidney transplantation program in Croatia, as a part of Eurotransplant, typing for HLA-A, -B, -C, -DRB1 and -DQB1 loci is mandatory both for recipients and donors. Sensitized patients, especially those highly sensitized, often extend their sensitization to HLA antigens of additional loci (HLA-DRB3/4/5, - DQA1, -DPB1 and -DPA1). HLA typing without inclusion of those loci is leading to inaccuracies during the organ allocation process and prolonged period for allocation. MATERIALS AND METHODS The real-time polymerase chain reaction method for 11 loci (HLA-A, -B, -C, DRB1, -DRB3/4/5, -DQB1, - DQA1, -DPB1 and -DPA1) is widely used as a sole method for HLA typing of deceased donors because of its simplified workflow. In the last six months, this method was introduced in the organ transplantation program in our Tissue Typing Centre. Potential DSAs are reported for each recipient at time of kidney allocation, with the assignment of the DSAs undertaken according to the donor’s PCR-SSP or rtPCR HLA typing. RESULTS Currently, among 307 patients on Eurotransplant kidney waiting list in Croatia, 116 (37.8%) patients are immunised, among which 38 (32.8%) of them are immunised against those additional HLA loci. The majority, 22/38 (57.9%), has HLA-DP antibodies, either only -DPA/B or in combination with other HLA class I or II antibodies. In the period of six months, 17 deceased donors were typed by rtPCR and kidney was offered to five highly sensitized patients. Three of them continued to transplantation due to beneficial additional typing results and for two patients, organ was rejected due to unacceptable HLA-DPB1 and allele specific -DRB3 antibodies. CONCLUSION Extension of HLA typing with additional loci speeds the process of allocation, avoids unnecessary organ transportation, reduces cold ischemia time and provides valuable information for decision on pretransplant and postransplant immunosuppressive therapy. Finally, this should increase the effectiveness and graft survival.

kidney allocation ; HLA typing

nije evidentirano