TY - JOUR
T1 - Scandiatransplant acceptable mismatch program-10 years with an effective strategy for transplanting highly sensitized patients
AU - Weinreich, Ilse
AU - Bengtsson, Mats
AU - Lauronen, Jouni
AU - Naper, Christian
AU - Lokk, Kaie
AU - Helanterä, Ilkka
AU - Andrésdóttir, Margrét Birna
AU - Sørensen, Søren Schwartz
AU - Wennberg, Lars
AU - Reisaeter, Anna Varberg
AU - Møller, Bjarne
AU - Koefoed-Nielsen, Pernille
N1 - © 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2022/12
Y1 - 2022/12
N2 - In March 2009, the Scandiatransplant acceptable mismatch program (STAMP) was introduced as a strategy toward improving kidney allocation to highly sensitized patients. Patients with a transplantability score ≤ 2% are potential candidates for the program. Samples are analyzed and acceptable antigens (HLA-A, B, C, DRB1, DRB3/4/5, DQB1, DQA1, DPB1, DPA1) are defined by the local tissue typing laboratory and finally evaluated by a steering committee. In the matching algorithm, patients have the highest priority when the donor's antigens are all among the recipient's own or acceptable HLA antigens. In the period from 2009 to 2020, we have transplanted 278 highly sensitized kidney patients through the program. The graft survival of the STAMP patients was compared with 9002 deceased donor kidney-transplanted patients, transplanted in the same time period. The 10-year graft survival was 73.4% (95% CI: 60.3-90.0) for STAMP and 82.9% (95% CI: 81.6-84.3) for the reference group. (p = .2). In conclusion, the 10-year allograft survival demonstrates that the STAMP allocation algorithm is immunological safe. The program is continuously monitored and evaluated, and the introduction of matching for all HLA loci is a huge improvement to the program and demonstrate technical adaptability as well as clinical flexibility in a de-centralized organization.
AB - In March 2009, the Scandiatransplant acceptable mismatch program (STAMP) was introduced as a strategy toward improving kidney allocation to highly sensitized patients. Patients with a transplantability score ≤ 2% are potential candidates for the program. Samples are analyzed and acceptable antigens (HLA-A, B, C, DRB1, DRB3/4/5, DQB1, DQA1, DPB1, DPA1) are defined by the local tissue typing laboratory and finally evaluated by a steering committee. In the matching algorithm, patients have the highest priority when the donor's antigens are all among the recipient's own or acceptable HLA antigens. In the period from 2009 to 2020, we have transplanted 278 highly sensitized kidney patients through the program. The graft survival of the STAMP patients was compared with 9002 deceased donor kidney-transplanted patients, transplanted in the same time period. The 10-year graft survival was 73.4% (95% CI: 60.3-90.0) for STAMP and 82.9% (95% CI: 81.6-84.3) for the reference group. (p = .2). In conclusion, the 10-year allograft survival demonstrates that the STAMP allocation algorithm is immunological safe. The program is continuously monitored and evaluated, and the introduction of matching for all HLA loci is a huge improvement to the program and demonstrate technical adaptability as well as clinical flexibility in a de-centralized organization.
KW - Humans
KW - Kidney Transplantation
KW - Histocompatibility Testing
KW - Tissue Donors
KW - HLA Antigens
KW - Graft Survival
UR - http://www.scopus.com/inward/record.url?scp=85137824292&partnerID=8YFLogxK
U2 - 10.1111/ajt.17182
DO - 10.1111/ajt.17182
M3 - Journal article
C2 - 36030513
SN - 1600-6135
VL - 22
SP - 2869
EP - 2879
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 12
ER -