Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

Sebastiaan Heidt, Geert W. Haasnoot, Marian D. Witvliet, Marissa J. H. van der Linden-van Oevelen, Elena G. Kamburova, Bram W. Wisse, Irma Joosten, Wil A. Allebes, Arnold van der Meer, Luuk B. Hilbrands, Marije C. Baas, Eric Spierings, Cornelis E. Hack, Franka E. van Reekum, Arjan D. van Zuilen, Marianne C. Verhaar, Michiel L. Bots, Adriaan C. A. D. Drop, Loes Plaisier, Marc A. J. Seelen & 26 others Jan-Stephan Sanders, Bouke G. Hepkema, Annechien J. A. Lambeck, Laura B. Bungener, Caroline Roozendaal, Marcel G. J. Tilanus, Christina E. Voorter, Lotte Wieten, Elly M. van Duijnhoven, Marielle A. C. J. Gelens, Maarten H. L. Christiaans, Frans J. van Ittersum, Shaikh A. Nurmohamed, Neubury M. Lardy, Wendy Swelsen, Karlijn A. M. I. van der Pant, Neelke C. van der Weerd, Ineke J. M. ten Berge, Frederike J. Bemelman, Andries Hoitsma, Paul J. M. van der Boog, Johan W. de Fijter, Michiel G. H. Betjes, Henny G. Otten, Dave L. Roelen, Frans H. J. Claas

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.
Original languageEnglish
JournalAmerican Journal of Transplantation
Volume19
DOIs
Publication statusPublished - 1 Oct 2019

Cite this

Heidt, S., Haasnoot, G. W., Witvliet, M. D., van der Linden-van Oevelen, M. J. H., Kamburova, E. G., Wisse, B. W., ... Claas, F. H. J. (2019). Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients. American Journal of Transplantation, 19. https://doi.org/10.1111/ajt.15486
Heidt, Sebastiaan ; Haasnoot, Geert W. ; Witvliet, Marian D. ; van der Linden-van Oevelen, Marissa J. H. ; Kamburova, Elena G. ; Wisse, Bram W. ; Joosten, Irma ; Allebes, Wil A. ; van der Meer, Arnold ; Hilbrands, Luuk B. ; Baas, Marije C. ; Spierings, Eric ; Hack, Cornelis E. ; van Reekum, Franka E. ; van Zuilen, Arjan D. ; Verhaar, Marianne C. ; Bots, Michiel L. ; Drop, Adriaan C. A. D. ; Plaisier, Loes ; Seelen, Marc A. J. ; Sanders, Jan-Stephan ; Hepkema, Bouke G. ; Lambeck, Annechien J. A. ; Bungener, Laura B. ; Roozendaal, Caroline ; Tilanus, Marcel G. J. ; Voorter, Christina E. ; Wieten, Lotte ; van Duijnhoven, Elly M. ; Gelens, Marielle A. C. J. ; Christiaans, Maarten H. L. ; van Ittersum, Frans J. ; Nurmohamed, Shaikh A. ; Lardy, Neubury M. ; Swelsen, Wendy ; van der Pant, Karlijn A. M. I. ; van der Weerd, Neelke C. ; ten Berge, Ineke J. M. ; Bemelman, Frederike J. ; Hoitsma, Andries ; van der Boog, Paul J. M. ; de Fijter, Johan W. ; Betjes, Michiel G. H. ; Otten, Henny G. ; Roelen, Dave L. ; Claas, Frans H. J. / Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients. In: American Journal of Transplantation. 2019 ; Vol. 19.
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title = "Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients",
abstract = "Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.",
author = "Sebastiaan Heidt and Haasnoot, {Geert W.} and Witvliet, {Marian D.} and {van der Linden-van Oevelen}, {Marissa J. H.} and Kamburova, {Elena G.} and Wisse, {Bram W.} and Irma Joosten and Allebes, {Wil A.} and {van der Meer}, Arnold and Hilbrands, {Luuk B.} and Baas, {Marije C.} and Eric Spierings and Hack, {Cornelis E.} and {van Reekum}, {Franka E.} and {van Zuilen}, {Arjan D.} and Verhaar, {Marianne C.} and Bots, {Michiel L.} and Drop, {Adriaan C. A. D.} and Loes Plaisier and Seelen, {Marc A. J.} and Jan-Stephan Sanders and Hepkema, {Bouke G.} and Lambeck, {Annechien J. A.} and Bungener, {Laura B.} and Caroline Roozendaal and Tilanus, {Marcel G. J.} and Voorter, {Christina E.} and Lotte Wieten and {van Duijnhoven}, {Elly M.} and Gelens, {Marielle A. C. J.} and Christiaans, {Maarten H. L.} and {van Ittersum}, {Frans J.} and Nurmohamed, {Shaikh A.} and Lardy, {Neubury M.} and Wendy Swelsen and {van der Pant}, {Karlijn A. M. I.} and {van der Weerd}, {Neelke C.} and {ten Berge}, {Ineke J. M.} and Bemelman, {Frederike J.} and Andries Hoitsma and {van der Boog}, {Paul J. M.} and {de Fijter}, {Johan W.} and Betjes, {Michiel G. H.} and Otten, {Henny G.} and Roelen, {Dave L.} and Claas, {Frans H. J.}",
year = "2019",
month = "10",
day = "1",
doi = "10.1111/ajt.15486",
language = "English",
volume = "19",
journal = "American Journal of Transplantation",
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publisher = "Wiley-Blackwell",

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Heidt, S, Haasnoot, GW, Witvliet, MD, van der Linden-van Oevelen, MJH, Kamburova, EG, Wisse, BW, Joosten, I, Allebes, WA, van der Meer, A, Hilbrands, LB, Baas, MC, Spierings, E, Hack, CE, van Reekum, FE, van Zuilen, AD, Verhaar, MC, Bots, ML, Drop, ACAD, Plaisier, L, Seelen, MAJ, Sanders, J-S, Hepkema, BG, Lambeck, AJA, Bungener, LB, Roozendaal, C, Tilanus, MGJ, Voorter, CE, Wieten, L, van Duijnhoven, EM, Gelens, MACJ, Christiaans, MHL, van Ittersum, FJ, Nurmohamed, SA, Lardy, NM, Swelsen, W, van der Pant, KAMI, van der Weerd, NC, ten Berge, IJM, Bemelman, FJ, Hoitsma, A, van der Boog, PJM, de Fijter, JW, Betjes, MGH, Otten, HG, Roelen, DL & Claas, FHJ 2019, 'Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients' American Journal of Transplantation, vol. 19. https://doi.org/10.1111/ajt.15486

Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients. / Heidt, Sebastiaan; Haasnoot, Geert W.; Witvliet, Marian D.; van der Linden-van Oevelen, Marissa J. H.; Kamburova, Elena G.; Wisse, Bram W.; Joosten, Irma; Allebes, Wil A.; van der Meer, Arnold; Hilbrands, Luuk B.; Baas, Marije C.; Spierings, Eric; Hack, Cornelis E.; van Reekum, Franka E.; van Zuilen, Arjan D.; Verhaar, Marianne C.; Bots, Michiel L.; Drop, Adriaan C. A. D.; Plaisier, Loes; Seelen, Marc A. J.; Sanders, Jan-Stephan; Hepkema, Bouke G.; Lambeck, Annechien J. A.; Bungener, Laura B.; Roozendaal, Caroline; Tilanus, Marcel G. J.; Voorter, Christina E.; Wieten, Lotte; van Duijnhoven, Elly M.; Gelens, Marielle A. C. J.; Christiaans, Maarten H. L.; van Ittersum, Frans J.; Nurmohamed, Shaikh A.; Lardy, Neubury M.; Swelsen, Wendy; van der Pant, Karlijn A. M. I.; van der Weerd, Neelke C.; ten Berge, Ineke J. M.; Bemelman, Frederike J.; Hoitsma, Andries; van der Boog, Paul J. M.; de Fijter, Johan W.; Betjes, Michiel G. H.; Otten, Henny G.; Roelen, Dave L.; Claas, Frans H. J.

In: American Journal of Transplantation, Vol. 19, 01.10.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients

AU - Heidt, Sebastiaan

AU - Haasnoot, Geert W.

AU - Witvliet, Marian D.

AU - van der Linden-van Oevelen, Marissa J. H.

AU - Kamburova, Elena G.

AU - Wisse, Bram W.

AU - Joosten, Irma

AU - Allebes, Wil A.

AU - van der Meer, Arnold

AU - Hilbrands, Luuk B.

AU - Baas, Marije C.

AU - Spierings, Eric

AU - Hack, Cornelis E.

AU - van Reekum, Franka E.

AU - van Zuilen, Arjan D.

AU - Verhaar, Marianne C.

AU - Bots, Michiel L.

AU - Drop, Adriaan C. A. D.

AU - Plaisier, Loes

AU - Seelen, Marc A. J.

AU - Sanders, Jan-Stephan

AU - Hepkema, Bouke G.

AU - Lambeck, Annechien J. A.

AU - Bungener, Laura B.

AU - Roozendaal, Caroline

AU - Tilanus, Marcel G. J.

AU - Voorter, Christina E.

AU - Wieten, Lotte

AU - van Duijnhoven, Elly M.

AU - Gelens, Marielle A. C. J.

AU - Christiaans, Maarten H. L.

AU - van Ittersum, Frans J.

AU - Nurmohamed, Shaikh A.

AU - Lardy, Neubury M.

AU - Swelsen, Wendy

AU - van der Pant, Karlijn A. M. I.

AU - van der Weerd, Neelke C.

AU - ten Berge, Ineke J. M.

AU - Bemelman, Frederike J.

AU - Hoitsma, Andries

AU - van der Boog, Paul J. M.

AU - de Fijter, Johan W.

AU - Betjes, Michiel G. H.

AU - Otten, Henny G.

AU - Roelen, Dave L.

AU - Claas, Frans H. J.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.

AB - Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31155833

U2 - 10.1111/ajt.15486

DO - 10.1111/ajt.15486

M3 - Article

VL - 19

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

ER -