The calculated panel reactive antibody policy: An advancement improving organ allocation

Current Opinion in Organ Transplantation

Volumn 16, Issue 4, 2011, Pages 404-409

  Leffell, Mary S ^a  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

calculated panel reactive antibody; HLA antibodies; panel reactive antibody; renal allocation; sensitization

Indexed keywords

HLA ANTIBODY; HLA ANTIGEN CLASS 1; HLA ANTIGEN CLASS 2;

ANTIBODY DETECTION; CALCULATED PANEL REACTIVE ANTIBODY POLICY; CROSS REACTION; DONOR SELECTION; ETHNIC DIFFERENCE; GRAFT RECIPIENT; HEALTH CARE POLICY; HISPANIC; HISTOCOMPATIBILITY; HLA SYSTEM; HOSPITAL ADMISSION; HUMAN; IMMUNOASSAY; KIDNEY DONOR; KIDNEY TRANSPLANTATION; MEDICAL SOCIETY; REGISTER; REVIEW; SENSITIZATION;

GENE FREQUENCY; HEALTH POLICY; HISTOCOMPATIBILITY; HISTOCOMPATIBILITY TESTING; HLA ANTIGENS; HUMANS; ISOANTIBODIES; KIDNEY TRANSPLANTATION; PROGRAM EVALUATION; TISSUE AND ORGAN PROCUREMENT; TISSUE DONORS; UNITED STATES; WAITING LISTS;

EID: 80051787572     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/MOT.0b013e3283489910     Document Type: Review

References (18)

1. National Organ Transplant Act, 1984. U.S. CFR Title 42, Section 273.
2. OPTN Policy 3.5. Organ distribution: Allocation of deceased kidneys. http:// optn.transplant.hrsa.gov/policiesAndBylaws/policies.asp.
3. Cecka JM. Calculated PRA (CPRA): The new measure of sensitization for transplant candidates. Am J Transplant 2009; 10:26-29. This article outlines the reasons behind the development of the CPRA policy, its basis, and its expected outcomes.
4. Delmonico FL, Fuller A, Cosimi AB, et al. New approaches to donor crossmatching and successful transplantation of highly sensitized patients. Transplantation 1983; 36:629-633. (Pubitemid 14216270)
5. Oldfather JW, Anderson CB, Phelan DL, et al. Prediction of crossmatch outcome in highly sensitized dialysis patients based on the identification of serum HLA antibodies. Transplantation 1986; 42:267-270. (Pubitemid 16020749)
6. MacQueen JM, Sanfillippo FP, Thacker L, Ward FE. Regional organ procurement (ROP) trays in renal allograft distribution and outcome. Clin Transplant 1997; 488-492. (Pubitemid 27460508)
7. Duquesnoy RJ, White LT, Fierst JW, et al. Multiscreen serum analysis of highly sensitized renal dialysis patients for antibodies toward public and private class I HLA determinants. Transplantation 1990; 50:427-437.
8. Thompson JS, Thacker L, Byrne J. Prospective trial of a predictive algorithm to transplant cadaver kidneys into highly sensitized patients. Transplantation 2002; 73:1274-1280. (Pubitemid 34454275)
9. Zachary AA, Montgomery RA, Leffell MS. Defining unacceptable HLA antigens. Cur Opin Transplant 2008; 13:405-410.
10. Zachary AA, Braun WE. Calculation of a predictive value for transplantation. Transplantation 1985; 39:316-318. (Pubitemid 15137834)
11. Zachary AA, Steinberg AG. Statistical analysis and application of HLA population data. In Rose NR, de Macario EC, Folds JD, et al., editors. Manual of clinical laboratory immunology. 5th ed. Washington, D.C.: ASM Press; 1997. pp. 1132-1140.
12. Leffell MS, Cherikh WS, Land GA, Zachary AA. Improved definition of HLA frequencies among minorities and applicability to estimates of transplant compatibility. Transplantation 2007; 83:964-972. (Pubitemid 46682739)
13. Harper AM. CPRA: A preliminary analysis. January 29, 2008. UNOS Research Department. http://optn.transplant.hrsa.gov/search.asp?qu=Committee+reports.
14. Cecka JM, Kucheryavaya AY, Reinsmoen NL, Leffell MS. Calculated PRA: Initial results show benefits for sensitized patients and a reduction in positive crossmatches. Am J Transplant 2010; 10:1-6. In this article, the authors present an analysis of the impact of the CPRA policy after 6 months of implementation noting not only the predicted decrease in organ refusals attributed to positive cross-matches, but also an unexpected significant increase in transplant rates among broadly sensitized candidates with CPRA values exceeding 80%.
15. Kucheryavaya AY. Evaluation of modification to OPTN/UNOS policy on using CPRA for allocation of deceased donor kidneys. July 13, 2010. UNOS Research Department. http://optn.transplant.hrsa.gov/search.asp? qu=Committee+reports.
16. Kucheryavaya AY. Evaluation of modification to OPTN/UNOS policy on using CPRA for allocation of deceased donor kidneys. January 17, 2011. UNOS Research Department. http://optn.transplant.hrsa.gov/search.asp? qu=Committee+reports.
17. Report of OPTN/UNOS Board of Directors Meeting, November 8-9, 2010. Policy notices: Http://optn.transplant.hrsa.gov/news/.
18. Singh P, Colombe BW, Doria C, et al. A pitfall in the current kidney allocation process using calculated PRA (CPRA) in patients undergoing desensitization. Am J Transplant 2010; 10:1947.