Saudi Journal of Kidney Diseases and Transplantation

EDITORIAL
Year
: 2007  |  Volume : 18  |  Issue : 3  |  Page : 346--348

Organ Sharing in Saudi Arabia: A Proposal


Ali H Hajeer 
 Immunopathology Laboratory (1122), Dept. of Pathology & Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

Correspondence Address:
Ali H Hajeer
Dept. of Pathology and Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426
Saudi Arabia




How to cite this article:
Hajeer AH. Organ Sharing in Saudi Arabia: A Proposal.Saudi J Kidney Dis Transpl 2007;18:346-348


How to cite this URL:
Hajeer AH. Organ Sharing in Saudi Arabia: A Proposal. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2022 Jun 25 ];18:346-348
Available from: https://www.sjkdt.org/text.asp?2007/18/3/346/33749


Full Text

Currently, deceased organ allocation in Saudi Arabia is done through a rotation system. Each of the centers involved will receive organs from deceased persons by turn. When a center receives a kidney, it selects a group of patients who are ABO compatible and cross matches them. Based on the patient's health, time on waiting list, and other factors (HLA matching is not one of these factors), the organ(s) will be allocated. So far, there are no written guidelines or a scoring system that can be used as a standard of practice in deceased organ allocation.

Matching of HLA antigens between donors and recipients improves the outcome of kidney transplantation. [1] Matching provides the greatest advantage when the donor and the recipient have no (zero) antigens mismatched or matching is identical at all six HLA loci.

Data from the United Network for Organ Sharing (UNOS) show that patients who are highly sensitized to HLA antigens have limited access to kidney transplantation. [2] Highly sensitized patients are predominantly females and gain their sensitized state through pregnancy, blood transfusions or from previous transplants that have been rejected. [2]

There are many strategies currently used to overcome sensitization in patients awaiting renal transplantation. Methods to reduce preformed antibodies have targeted both the removal of existing antibodies and preventing their subsequent formation. These strategies include plasmapheresis, immunoadsorption, and treatment with intravenous immunoglobulin. [3],[4],[5]

HLA matching in renal transplantation remains one of the most important factors governing outcome of the graft. Opelz et al. [6] studied the influence of HLA compatibility on organ transplant survival in more than 150,000 recipients transplanted from 1987 to 1997 at transplant centers participating in the Collaborative Transplant Study. One of their significant results was that among first-deceased organ transplant recipients with an antibody reactivity >50%, the difference in graft survival at 5 years between patients with zero or six mismatches reached 30%. [6]

Results from the United States suggest that HLA mismatching in renal transplant has big economic implications. Average Medicare payments for renal transplant recipients in the 3 years post-transplantation increased from US$60,000 per patient for fully HLA-matched kidneys to US$80,000 for kidneys with six HLA mismatches between donor and recipient. [7]

Data from a prospective study on a predictive program for highly sensitized patients suggested that identifying a list of acceptable and unacceptable HLA antigens could improve the access of highly sensitized patients to a successful renal transplant. [8]

Thus, many studies worldwide have demonstrated the significant effect of HLA matching on the outcome of graft survival in renal transplantation, especially in highly sensitized patients. Several programs worldwide have modified their allocation of deceased grafts (kidney) in order to integrate HLA matching as part of their selection criteria. [9],[10],[11],[12],[13]

 Proposal



In the context of the data presented earlier, we propose establishing a central database of highly sensitized patients in Saudi Arabia. The database should include the following: updated patient list from all participating centers: patients' HLA type, panel reactive antibodies (PRA) (historical and updated), and a list of unacceptable antigens. The unacceptable antigens are defined as the HLA antigens that reacted positive in the patient's PRA or previously transplanted kidney HLA type. Once a kidney is received by the center, the procedure will be carried out as usual; and once the donor HLA type is known, it will be sent to the central database to compare with the highly sensitized patient HLA types. If a patient is found zero mismatched at HLA-A, -B and -DR, and there is no unacceptable antigen(s) in the donor HLA type, priority is given to that patient. The kidney will be dispatched to the center where the patient is prepared for cross matching and surgery.

References

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