Abstract
650 Opelz, et al and Hosenpud, et al have shown that HLA matching may be an important determinant in cardiac TNX. Sharing over any distance, however, is virtually impossible because of the much shorter tolerable cold ischemia time for cardiac as compared to kidney transplants. Because of their greater frequency and less restrictive racial representation, we hypothesized that CREG-DR matching might offer the opportunity to improve allocation within a single center or OPO without the risk of transportation. UNOS performed a retrospective analysis of 13,511 cardiac TNX performed by UNOS centers between 10/87 and 7/95 for whom there was complete HLA-A,B, and DR typing. For Class I, conventional HLA-A,B matching was compared to the 10 CREG in Rodey and Fuller's Matching Strategy I and for Class II, the broad DR 1-10 antigens were analyzed. One and 3 year graft survival (GS) was determined and the half-life after the first year (T 1/2) was calculated. Whereas HLA-A,B and DR mismatching had a progressively negative effect on GS in white, it was not seen in non-white recipients. However, there was a statistically significant positive effect of HLA-DR matching on GS after the first year in both racial groups. Furthermore, in ODR mismatched grafts, 0 and 1 CREG mismatches identified 488 whose survival was equal or superior to 0 and 1 93 conventional HLA-A,B. Conclusions: As in kidney transplantation, there is a significant effect of race on GS. Within relatively small geographic areas and the constraints for an urgent need for transplantation, the number of cardiac transplants with better survival could be increased by emphasizing OCREG, ODR mismatched transplants. TablesTable 1: Effect of Race on SEOPF Cardiac TNX SurvivalTable 2: Effect of HLA-DR Mismatching (mm) on Cardiac TNX Survival
Published Version
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