Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation

Background: In October 1987, the United Network for Organ Sharing (UNOS) es tablished a national kidney-sharing program to increase the number of HLA-m atched transplantations. Since then, over 7500 cadaveric kidneys have been shipped to centers in 48 states for transplantation to HLA-matched patients . We evaluated the efficacy of the program during its first 12 years of ope ration. Methods: We compared the rates of rejection and actuarial graft survival fo r 7614 HLA-matched and 81,364 HLA-mismatched cadaveric kidney transplantati ons reported to the UNOS Scientific Registry between October 1987 and Septe mber 1999. To assess the effects of the extended period of ischemia associa ted with shipping HLA-matched kidneys, we identified 3562 pairs of cadaveri c kidneys in which one kidney went to an HLA-matched recipient and the othe r went to an HLA-mismatched recipient. Results: The estimated 10-year rate of graft survival was 52 percent for HL A-matched transplants, as compared with 37 percent for HLA-mismatched trans plants. The estimated half-lives of the transplants were 12.5 years and 8.6 years, respectively, and the mean duration of cold ischemia was 23 hours a nd 22 hours, respectively. After adjustment for the effects of demographic characteristics, at 10 years the overall rates of graft survival and the ra tes of functional-graft survival (with data censored on patients who died w ith a functioning graft) were 10 percent and 11 percent higher, respectivel y, for HLA-matched transplants than for HLA-mismatched transplants. Among 3 562 pairs of kidneys, HLA-matched transplants had higher rates of survival, a lower incidence of episodes of rejection, and a lower risk of loss as a result of rejection. Conclusions: A superior graft outcome with little increase in the duration of cold ischemia justifies national sharing of HLA-matched kidney transplan ts. (N Engl J Med 2000;343:1078-84.) (C) 2000, Massachusetts Medical Societ y.