Bootcongres

Kidney transplantation is the best option after 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 amongst 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 retrainsplantation. The present algorithm for allocation is amongst others based on matching for the HLA antigen, which were originally defined by antibodies in serological typing. However, multiple studies suggest that this algorithm needs adaptation and that other parameters which are currently not included may assist in improving graft survival rates. To this end, we will use a multicenter-based evaluation on 5.429 patients transplanted between 1995-2005. 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 distilled which will lead to the identification of additional parameters to be included in future matching algorithms aiming at the extension of the half-life of transplanted kidneys and a diminished HLA immunization. Simulation studies should reveal the number of patients having a direct benefit from an improved matching, the effect on shortening of waiting lists, and the decrease in waiting time.