THE HIGH-GRADE MATCH KIDNEY SHARING ALGORITHM OF THE SOUTH-EASTERN-ORGAN-PROCUREMENT-FOUNDATION (SEOPF) - ALTERING RECIPIENT DEMOGRAPHICS THROUGH IMPROVED MATCHING

Background. Studies of kidneys shared through the South-Eastern Organ Procurement Foundation (SEOPF) have shown that regional organ procurem ent (ROP) trays can predict negative crossmatch in highly sensitized p atients when the HLA match is of a high grade, In an attempt to offer more well-matched kidneys to highly sensitized patients, SEOPF organiz ed the High Grade Match (HGM) Program. Methods. This United Network fo r Organ Sharing (UNOS)-approved allocation variance requires mandatory sharing of all kidneys by participating centers after UNOS mandatory sharing requirements have been met. The HGM levels of sharing are: (1) 0 A,B mismatch (MM); panel-reactive antibody (PRA) greater than or eq ual to 40%; nagative ROP crossmatch; (2) 0 B,DR MM with greater than o r equal to 40% PRa; negtive ROP crossmatch; (3) 0 B,DR MM with PRA <40 % Non-HGM cadaveric transplants at the same participating centers-loca lly or distally procured-sere as the control group. Results. During th e first 18 months of this program, the 23 participating centers shred 124 kidneys of the 1592 that were available. Well-matched kidneys (two mismatches or less) accounted for 91.1% in the HGM group, but only 19 % of the controls (P<0.0001). Highly sensitized patients (PRA greater than or equal to 40%) represented 13.8% of the HGM group, but only 3.3 % of the non-HGM group (P<.0001). With HGM kidneys, there was a shift in recipient demographics. patients wit blood group O, female patients , older patients, and retransplanted patients all accounted for signif icantly larger percentages of the HGM group compared with the non-HGM control group. The racial composition of the recipients of high-grade matches was, however, no different than that of the control recipients at the same centers. Conclusion. The HGM Program resulted in longer i schemia times, but graft survival was not affected. The 1-year actuari al graft survival rate (Kaplan-Meier) for HGM kidneys was not differen t from the control cadaveric graft survival rate. By sharing kidneys b ased on improved HLA matches with consideration for high PRA, the HGM Program offered more transplant opportunities to women, blood group O recipients, retransplants, and older patients.