Improving Access to HLA-Matched Kidney Transplants for African American Patients
IntroductionKidney transplants fail more often in Black than in non-Black (White, non-Black Hispanic, and Asian) recipients. We used the estimated physicochemical immunogenicity for polymorphic amino acids of donor/recipient HLAs to select weakly immunogenic kidney transplants for Black vs. White or...
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2022.832488/full |
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| author | Dulat Bekbolsynov Beata Mierzejewska Sadik Khuder Obinna Ekwenna Michael Rees Michael Rees Michael Rees Robert C. Green Stanislaw M. Stepkowski |
| author_facet | Dulat Bekbolsynov Beata Mierzejewska Sadik Khuder Obinna Ekwenna Michael Rees Michael Rees Michael Rees Robert C. Green Stanislaw M. Stepkowski |
| author_sort | Dulat Bekbolsynov |
| collection | DOAJ |
| description | IntroductionKidney transplants fail more often in Black than in non-Black (White, non-Black Hispanic, and Asian) recipients. We used the estimated physicochemical immunogenicity for polymorphic amino acids of donor/recipient HLAs to select weakly immunogenic kidney transplants for Black vs. White or non-Black patients.MethodsOPTN data for 65,040 donor/recipient pairs over a 20-year period were used to calculate the individual physicochemical immunogenicity by hydrophobic, electrostatic and amino acid mismatch scores (HMS, EMS, AMS) and graft-survival outcomes for Black vs. White or vs. non-Black recipients, using Kaplan-Meier survival and Cox regression analyses. Simulations for re-matching recipients with donors were based on race-adjusted HMS thresholds with clinically achievable allocations.ResultsThe retrospective median kidney graft survival was 12.0 years in Black vs. 18.6 years in White (6.6-year difference; p>0.001) and 18.4 years in non-Black (6.4-year difference; p>0.01) recipients. Only 0.7% of Blacks received transplants matched at HLA-A/B/DR/DQ (HMS=0) vs. 8.1% in Whites (p<0.001). Among fully matched Blacks (HMS=0), graft survival was 16.1-years and in well-matched Blacks (HMS ≤ 3.0) it was 14.0-years. Whites had 21.6-years survival at HMS ≤ 3.0 and 18.7-years at HMS ≤ 7.0 whereas non-Blacks had 22.0-year at HMS ≤ 3.0 and 18.7-year at HMS ≤ 7.0, confirming that higher HMS thresholds produced excellent survival. Simulation of ABO-compatible donor-recipient pairs using race-adjusted HMS thresholds identified weakly immunogenic matches at HMS=0 for 6.1% Blacks and 18.0% at HMS ≤ 3.0. Despite prioritizing Black patients, non-Black patients could be matched at the same level as in current allocation (47.0% vs 56.5%, at HMS ≤ 7.0).ConclusionsRace-adjusted HMS (EMS, AMS)-based allocation increased the number of weakly immunogenic donors for Black patients, while still providing excellent options for non-Black recipients. |
| first_indexed | 2024-12-13T07:56:35Z |
| format | Article |
| id | doaj.art-5af031ed008a4893a27226c347c51d54 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-13T07:56:35Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj.art-5af031ed008a4893a27226c347c51d542022-12-21T23:54:32ZengFrontiers Media S.A.Frontiers in Immunology1664-32242022-03-011310.3389/fimmu.2022.832488832488Improving Access to HLA-Matched Kidney Transplants for African American PatientsDulat Bekbolsynov0Beata Mierzejewska1Sadik Khuder2Obinna Ekwenna3Michael Rees4Michael Rees5Michael Rees6Robert C. Green7Stanislaw M. Stepkowski8Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United StatesDepartment of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United StatesDepartment of Medicine and Public Health, University of Toledo, Toledo, OH, United StatesDepartment of Urology, College of Medicine, University of Toledo, Toledo, OH, United StatesDepartment of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United StatesDepartment of Urology, College of Medicine, University of Toledo, Toledo, OH, United StatesThe of Alliance for Paired Donation, Maumee, OH, United StatesDepartment of Computer Science, Bowling Green State University, Bowling Green, OH, United StatesDepartment of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United StatesIntroductionKidney transplants fail more often in Black than in non-Black (White, non-Black Hispanic, and Asian) recipients. We used the estimated physicochemical immunogenicity for polymorphic amino acids of donor/recipient HLAs to select weakly immunogenic kidney transplants for Black vs. White or non-Black patients.MethodsOPTN data for 65,040 donor/recipient pairs over a 20-year period were used to calculate the individual physicochemical immunogenicity by hydrophobic, electrostatic and amino acid mismatch scores (HMS, EMS, AMS) and graft-survival outcomes for Black vs. White or vs. non-Black recipients, using Kaplan-Meier survival and Cox regression analyses. Simulations for re-matching recipients with donors were based on race-adjusted HMS thresholds with clinically achievable allocations.ResultsThe retrospective median kidney graft survival was 12.0 years in Black vs. 18.6 years in White (6.6-year difference; p>0.001) and 18.4 years in non-Black (6.4-year difference; p>0.01) recipients. Only 0.7% of Blacks received transplants matched at HLA-A/B/DR/DQ (HMS=0) vs. 8.1% in Whites (p<0.001). Among fully matched Blacks (HMS=0), graft survival was 16.1-years and in well-matched Blacks (HMS ≤ 3.0) it was 14.0-years. Whites had 21.6-years survival at HMS ≤ 3.0 and 18.7-years at HMS ≤ 7.0 whereas non-Blacks had 22.0-year at HMS ≤ 3.0 and 18.7-year at HMS ≤ 7.0, confirming that higher HMS thresholds produced excellent survival. Simulation of ABO-compatible donor-recipient pairs using race-adjusted HMS thresholds identified weakly immunogenic matches at HMS=0 for 6.1% Blacks and 18.0% at HMS ≤ 3.0. Despite prioritizing Black patients, non-Black patients could be matched at the same level as in current allocation (47.0% vs 56.5%, at HMS ≤ 7.0).ConclusionsRace-adjusted HMS (EMS, AMS)-based allocation increased the number of weakly immunogenic donors for Black patients, while still providing excellent options for non-Black recipients.https://www.frontiersin.org/articles/10.3389/fimmu.2022.832488/fullkidney transplantationtransplant survivalraceallocationhuman leukocyte antigenhuman leukocyte antigen mismatch |
| spellingShingle | Dulat Bekbolsynov Beata Mierzejewska Sadik Khuder Obinna Ekwenna Michael Rees Michael Rees Michael Rees Robert C. Green Stanislaw M. Stepkowski Improving Access to HLA-Matched Kidney Transplants for African American Patients Frontiers in Immunology kidney transplantation transplant survival race allocation human leukocyte antigen human leukocyte antigen mismatch |
| title | Improving Access to HLA-Matched Kidney Transplants for African American Patients |
| title_full | Improving Access to HLA-Matched Kidney Transplants for African American Patients |
| title_fullStr | Improving Access to HLA-Matched Kidney Transplants for African American Patients |
| title_full_unstemmed | Improving Access to HLA-Matched Kidney Transplants for African American Patients |
| title_short | Improving Access to HLA-Matched Kidney Transplants for African American Patients |
| title_sort | improving access to hla matched kidney transplants for african american patients |
| topic | kidney transplantation transplant survival race allocation human leukocyte antigen human leukocyte antigen mismatch |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2022.832488/full |
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