National allocation of cadaveric kidneys by HLA matching: projected effect on outcome and costs

Article Abstract:

A major concern following organ transplants is whether the donated organ will survive inside the recipient's body. Recent studies involving kidney transplants have shown that the more closely the tissue in the donor kidney matches that of the recipient, the more likely the kidney is to survive. The matching system is based on a protein complex called HLA (human lymphocyte antigens). These proteins are used by the immune system to identify the body's own tissues and to distinguish them from foreign tissues, in this case the donor organ, which the immune system would otherwise attempt to destroy. Each person has a different set of HLA proteins. The better the match between the HLA proteins of the donor and recipient (the more antigens they have in common), the better the chance of organ survival following transplant. It has been suggested that a nationwide HLA matching program be established for matching kidney donors and recipients. To address this issue, a study was performed to evaluate the effort, cost, and benefit of such a program. Rates of organ survival following transplant (graft survival rate) were obtained from the medical records of 22,190 kidney recipients, and the rates were compared to the degree of HLA matching between the donor and recipient. The costs of a nationwide HLA matching system were compared with the costs of using drug treatments with cyclosporine to enhance the graft survival rate. The results of this study show that graft survival rate at 10 years is enhanced by 5 percent with HLA matching and by 7 percent with cyclosporine. The estimated five-year cost of a nationwide HLA matching program for 7,000 recipients is $6.5 million less than that estimated for using cyclosporine. It is suggested that a nationwide HLA matching program for kidney transplants should be initiated, as it will improve the rate of graft survival to the same extent as cyclosporine but will cost less. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Physiological aspects

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Bone marrow transplantation after the Chernobyl nuclear accident

Article Abstract:

The April 1986 accident at the Chernobly nuclear power station in the Soviet Union gave 200 people large doses of radiation to the entire body. Thirteen people exposed to between 5.6 and 13.4 Grays (measure of the amount of radioactive energy received per gram of body tissue) received bone marrow transplants. Two such transplant recipients, who received estimated doses of 5.6 and 8.7 grays, are alive more than three years after their exposure. The other 11 victims died: 5 from burns, 3 from cellular debris clogging the spaces between the air sacs of inflamed lungs, 2 because their disease-fighting immune system fought the marrow transplant as a foreign invader, and 1 from a sudden and severe kidney failure and lung problems. Nine transplant recipients recovered the ability to make disease-fighting white blood cells in their own bone marrow; six of these underwent transient partial transplantation before their own marrow recovered. Disease caused by the immune system fighting the transplant as a foreign invader (graft-versus-host disease) was openly observable in four patients, and was suspected in two others. Thus, although it is possible to recover the ability to produce blood cells in the bone marrow after exposure to between 5.6 and 13.4 grays of radiation, it is unknown whether such recovery is more likely after a transient marrow transplant. Because such large doses of radiation damage the body in many ways, bone marrow recovery does not guarantee survival. The risk of the immune system attacking the transplant must be taken into account in decisions regarding transplantation.

Health aspects, Care and treatment, Case studies, Laws, regulations and rules, Occupational health and safety, Occupational safety and health, Bone marrow, Bone marrow transplantation, Health risk assessment, Chernobyl, Ukraine, Nuclear Accident, 1986, Radiation injuries, Great Britain

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Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors

Article Abstract:

Better HLA matching may may improve the long-term success of kidney transplants. HLA matching involves matching the HLA tissue antigens of the organ donor to those of the transplant recipient. A survey compared 1,004 first-time kidney transplant recipients who were HLA matched to 22,188 first-time kidney transplant recipients who received a kidney that was mismatched for at least one HLA antigen. Among the patients who underwent their first kidney transplant, 88% of the patients who received a HLA-matched kidney had a functioning kidney one year after transplantation, compared with 79% of those who received a mismatched kidney. One year after transplantation, the half-life, or the time at which half the transplanted kidneys would fail, of matched kidneys was estimated at 17.3 years, compared with 7.8 years for the mismatched kidneys.

Usage, Causes of, Graft rejection

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