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Organ Allocation

HLA matching and minority transplants

In 2003, the US kidney allocation system was loosened to eliminate HLA-B similarity. (Improvement in anti-rejection meds made this possible) During the first six years after the change, total number of deceased donor transplants rose 23% in comparison to the six years prior to the change, including 40% increase for minorities.

There appeared to be no adverse effect on graft survival after two years.

And that part nags at me a bit. They tracked for six years, and only looked at the two year graft survival rate? Why didn’t they include the five-year rate? Sure, their sample rate would be reduced by approximately 3/5, but considering they were dealing with nearly 109,000 transplants, and the transplant industry routinely publishes living donors studies with ten to twenty subjects, I’m thinking 40,000+ would still be considered valid.

Obviously I have no way of knowing, but my concern is that the five year isn’t quite so rosy. And what about the cancer rate in the recipients due to the increased use of anti-rejection meds? Any studies forthcoming on that?

Ashby VB, Port FK, Wolfe RA, Wynn JJ, Williams WW, Roberts JP, & Leichtman AB (2011). Transplanting Kidneys Without Points for HLA-B Matching: Consequences of the Policy Change. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons PMID: 21672159

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