ORGAN EXCHANGE IN A REGIONAL KIDNEY-TRANS PLANT PROGRAM - EFFECTS ON PATIENTS ACCESS TO TRANSPLANT AND DECREE OF HISTOCOMPATIBILITY

We analyzed organ exchange (OE) in a regional kidney transplant (KT) p rogram during 13 years. Our policy promoted the sharing of organs for clinical urgencies, hyperimmunized patients and pediatric patients and was based on HLA matching. Of the 1,475 KT performed 40 % were implan ted in a transplant centre other than that in which it was removed. Ou r conclusions were: 1. OE activity tends to decrease with time due to a restriction in the flow of kidneys from the areas with a more active procurement activity. 2. OE increased by 100 % the possibilities of K T for those patients considered preferential (pediatric patients, hype rimmunized patients and clinical emergencies). 3. Among the non-prefer ential patients, OE increases HLA compatibility, especially at the DR locus: we had 16 % more cases with more favourable compatibility (OI i ncompatibilities in HLA B + DR). 4. Due to its voluntary nature, OE am ong the different areas of the region has been limited. As a consequen ce, OE had little effect on the differences existing in patients acces s to KT caused by the different capacities of organ procurement betwee n the different areas. We consider that OE has been an advantage for p referential patients and has given a higher HLA compatibility with an increase of the theoretical survival rates of KT. Nevertheless, the ci rcunstances in which this effort has been carried out in our region (s hort waiting list, optative character of the sharing) has limited the scope of its effects.