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Izbira možnih sprejemalcev za transplantacijo ledvice umrlih dajalcev v Sloveniji - imunogenetska merila
Bohinjec, Mateja ...
Cadaveric kidney transplantation in Slovenia depends exclusively on organs retrieved by the regional donor center. To optimize the transplantation success-rate we are following a protocol which ...enables us to select among patients on the waiting list recipients with the highest level of histocompatibility and the lowest potential immunological risk with regard to the given donor. The following information on potential kidney recipients is available from the database at the Tissue Typing Center: blood group ABO, phenotype HLA-A, B, DR, level of panel reactive lymphocytotoxic alloantibodiesthroughout the pretransplant period. ldentified specificities ofHLA alloreactive antibodies are declared as "prohibited missmataches". The recipient selection is performed in three subsequent steps. Step 1. Exclusion from further consideration of patients incompatible with the donor. The potential donor is typed for ABO blood groups and HLA antigens. Parallel to serologic typing of the donor, a collective cross-match test is performed using his lymphcytes and current sera of all ABO compatible patients on the waiting list. Patients with donor specific cytotoxins are definitely excluded.Equally excluded are patients if forbidden mismatches with the donor are in question. Step 2. Selection of recipients based on HLA matching with the donor. The patients not excluded by previous criteria are ranked accordingto the number of matching antigens, respecting the following hierarchy: HLA-DR > HLA-B > HLA-A. Step 3. Patients of the highest rank are clinically evaluated. In those proposed as candidates for transplantation, a pre-transplant cross-match is performed. A negative outcome of the test is obligatory.
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