Balancing Equity and HLA Matching in Deceased-Donor Kidney Allocation with Eplet Mismatch.

Autor:	Mankowski MA; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA. Electronic address: michal.mankowski@nyulangone.com., Gragert L; Division of Biomedical Informatics and Genomics, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA., Keating B; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Lonze BE; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Segev DL; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., Montgomery R; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., Gentry SE; Transplant Institute, NYU Langone Health, New York, New York; Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA., Mangiola M; Transplant Institute, NYU Langone Health, New York, New York.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2024 Dec 02. Date of Electronic Publication: 2024 Dec 02.
DOI:	10.1016/j.ajt.2024.11.030
Abstrakt:	HLA antigen-level matching in US kidney allocation has been de-emphasized due to its role in elevating racial disparities. Molecular matching based on eplets might improve risk stratification compared to antigen matching, but the magnitude of racial disparities in molecular matching is not known. To assign eplets unambiguously, we utilized a cohort of 5193 individuals with high resolution allele-level HLA genotypes from the National Kidney Registry. Using repeated random sampling to simulate donor-recipient genotype pairings based on the ethnic composition of the historical US deceased donor pool, we profiled the percentage of well-matched donors available for candidates by ethnicity. The prevalence of well-matched donors with zero-DR/DQ eplet mismatch was 3-fold less racially disparate for Black and Asian candidates and 2-fold less for Latino candidates compared to zero-ABDR antigen mismatches. Compared to zero-DR antigen mismatch, zero-DR eplet mismatch was 1.33-fold more racially disparate for Asian and 1.28-fold more for Latino, with similar disparity for Black candidates, whereas zero-DQ eplet mismatch reduced disparities, showing 1.26-fold less disparity for Black, 1.14-fold less for Latino, but 1.26-fold higher for Asian candidates. The prevalence of well-matched donors for candidates of different ethnicities varied according to which molecules were chosen to define a low-risk match. Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michal Mankowski, Loren Gragert reports financial support was provided by National Institute of Diabetes and Digestive and Kidney Diseases. Brendan Keating, Dorry Segev, Bonnie Lonze reports financial support was provided by National Institute of Allergy and Infectious Diseases. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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