מתוך medicontext.co.il
By Will Boggs, MD
WESTPORT, CT (Reuters Health) – The risk of failure of HLA-mismatched kidneys is increased during the first year after transplantation if the organs were shipped from distant locations, according to a report in the October 25th issue of The New England Journal of Medicine.
Whether the increased duration of cold ischemia necessitated by the national sharing of organs affects graft survival remains an unsettled concern, the authors explain.
Dr. Kevin C. Mange from the University of Pennsylvania in Philadelphia and colleagues used data from the United Network for Organ Sharing to compare graft failure rates of 5446 kidney pairs where one kidney was transplanted locally and the other was shipped for transplantation elsewhere.
In a multivariate model that adjusted for known allograft failure risk factors, shipped allografts had a higher rate of failure than did kidneys that were transplanted locally, especially during the first year after transplantation, the authors report.
The disparity in graft survival was more notable after adjustment for the degree of HLA mismatching, suggesting, the investigators note, "that HLA mismatching and the duration of cold ischemia are both important factors in the observed differences in survival between shipped and locally transplanted allografts, but they offset each other."
When further adjustments were made to account for the number of HLA mismatches, the report indicates, kidney shipment was associated with a 17% increase in the risk of allograft failure in the first year after transplantation. Adjustment for cold ischemia time attenuated this increased risk.
"The ramifications of shipping kidneys in this country have previously been overshadowed by the desire to allocate a zero HLA-mismatched kidney," Dr. Mange told Reuters Health. "Organ policy, if it will continue to strive for maximal survival of a scarce resource, needs to consider the findings of this as well as other studies that have examined issues related to this article."
Dr. Mange also emphasized, "Shipment of kidneys is an issue because it occurs, in part, due to the national shortage of kidneys (presently 40,000 kidneys are needed). The best way to minimize cold ischemia time and the need to ship organs is to increase the number of donors."
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