The PROCARE consortium: toward an improved allocation strategy for kidney allografts

H.G. Otten, I. Joosten, W.A. Allebes, A. van der Meer, L.B. Hilbrands, M. Baas, E. Spierings, C.E. Hack, F. van Reekum, A.D. van Zuilen, M.C. Verhaar, M.L. Bots, M.A. Seelen, J.S. Sanders, B.G. Hepkema, A.J. Lambeck, L.B. Bungener, C. Roozendaal, M G. Tilanus, J. VanderlochtC.E. Voorter, L. Wieten, E. van Duijnhoven, M. Gelens, M.H. Christiaans, F. van Ittersum, A. Nurmohamed, N.M. Lardy, W.T. Swelsen, K.A. van der Donselaar van der Pant, N.C. van der Weerd, I.J. ten Berge, F.J. Bemelman, A.J. Hoitsma, J.W. de Fijter, M.G. Betjes, D.L. Roelen, F.H. Claas

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Abstract

Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time.
Original languageEnglish
Pages (from-to)184-190
Number of pages7
JournalTransplant Immunology
Volume31
Issue number4
DOIs
Publication statusPublished - Oct 2014

Keywords

  • Kidney transplantation
  • HLA antibodies
  • Autoantibodies
  • Gene polymorphisms
  • T and B cell epitopes
  • NON-HLA ANTIBODIES
  • RENAL-TRANSPLANTATION
  • IMMUNOGLOBULIN-G
  • RISK-FACTOR
  • COMPLEMENT
  • RECEPTOR
  • DONOR
  • CELL
  • REJECTION
  • IDENTIFICATION

Cite this

Otten, H. G., Joosten, I., Allebes, W. A., van der Meer, A., Hilbrands, L. B., Baas, M., Spierings, E., Hack, C. E., van Reekum, F., van Zuilen, A. D., Verhaar, M. C., Bots, M. L., Seelen, M. A., Sanders, J. S., Hepkema, B. G., Lambeck, A. J., Bungener, L. B., Roozendaal, C., Tilanus, M. G., ... Claas, F. H. (2014). The PROCARE consortium: toward an improved allocation strategy for kidney allografts. Transplant Immunology, 31(4), 184-190. https://doi.org/10.1016/j.trim.2014.09.008