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Deceased Organ Donation

Once Again, Tissue Matching Matters

Reminder: transplants are not cures. They are, in fact, a treatment for kidney disease. The vast majority of recipients will need multiple transplants to achieve a normal life span.

Recipients must take anti-rejections (aka immunosuppressents) when they have a transplant to keep their body from attacking the transplanted organ. The greater the match between the recipient and the donated organ, the less apt the recipient’s body is to attack, and the longer the graft (transplanted organ) will survive (according to SRTR.org data).

However, advances in anti-rejection medications have resulted in certain transplant surgeons minimizing the importance of HLA matching, and more zero-match transplants are taking now than ever before.

But what happens when a transplant fails, as it usually, eventually does? Recipients are generally then “sensitized”, meaning their body has developed certain antibodies, which makes it that much more difficult to find a second/third/etc. suitable organ.

 
The authors analyzed the relationship between donor mismatches, and the development of specific HLA antibodies (sensitization). What they found was:

 

Thus, the risk of allosensitization following failure of a first renal transplant increases incrementally with the number of mismatches at all HLA loci assessed.

 
Once again, HLA and tissue matching *is* important, not only for graft survival, but for the recipient’s future chance of obtaining additional transplants.

4 replies on “Once Again, Tissue Matching Matters”

a fully matched organ is not an option unless from an identical twin. Even “fully matched ” siblings (or other) will have different minor tissue type alleles

In the U.S. the emphasis is, for many in the transplant industry, a living donor transplant at any cost. Too many stories abound of surgeons minimizing the importance of the tissue match, which leads both LDs and recipients to believe that it’s not important. The fact remains: HLA mismatch affects graft survival, and graft function. Better tissue match also lessens the need for anti-rejection medications, which carry substantial side effects, including a significant risk of developing cancer.

This is exactly what happened between my recipient and I. The surgeon without my knowledge used my “0” matched kidney to transplant into my recipient. ( I was never told that we were a 0 match )
The transplant failed within 6 months after futile attempts to save it by prescribing very high does of immune suppressant drugs. By the time they realized that they had given too much drugs, the kidney became infected with the BK virus- which is a very real risk in renal transplant and use of anti-rejection drugs.
They tried to taper off the drugs, but it was too late- the kidney had been destroyed.
Bottom line is that larger doses of ant-rejection drugs were prescribed because they were trying to MAKE a 0 match transplant work.
It is important that potential donors know the level of HLA match that they are with the intended recipient and that they are educated about the increased risk of graft failure with mismatched kidneys. The greater the HLA match the greater the chances for a successful outcome.
My kidney was thrown in the trash after a 6 month battle to save it and now my recipient has 100% antibodies and most likely will never be able to get another transplant.:(

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