Donation, allocation, and ischemic reperfusion injury
Current Status of the Scandiatransplant Acceptable Mismatch Program

https://doi.org/10.1016/j.transproceed.2012.10.010Get rights and content

Abstract

This article describes the Scandiatransplant Acceptable Mismatch Program (STAMP), which was set into action in 2009. The aim of STAMP is to define human leukocyte antigens (HLA) toward which the potential kidney recipient has not developed antibodies, as “acceptable mismatches” in the Scandiatransplant database. In many cases this may improve the probability for a highly immunized recipient to receive a suitable kidney graft from a deceased donor. Using data extracted from the Scandiatransplant database on the outcomes of the program after the first 3 years, 31/115 recipients included in the program have undergone transplantation. From 2008 to 2011 the mean waiting time for highly immunized patients has decreased from 42 to 37 months. Continuous evaluation and follow-up of the program is essential to improve the procedures and outcomes. Calculation of transplantability based on a given set of acceptable mismatches was added to the program in 2011, based on the historical deceased donor pool providing the possibility of a specific patient to receive a kidney through STAMP. It is still a challenge for the tissue typing laboratories to determine which detected HLA antibodies are clinical relevant. We concluded that STAMP has had the intended effects, however adjustments and improvements is an ongoing process. As an improvment of the program HLA-C was added to the STAMP search algorithm in September 2012.

Section snippets

Methodology

The data used in this study were extracted from the Scandiatransplant database, which covers a wide range of organ donors, recipients, and follow-up information. Scandiatransplant has a decentralized organization with a small central office that takes care of developments and maintains the database. The data input depends on the users of the database at each transplantation center within Scandiatransplant. A variety of quality controls on the data registrations are performed by the central

Description of STAMP

The program seeks to extend recipients having given HLA types with all acceptable HLA mismatches including splits of HLA-A, B, C, DR, and DQ alleles. When kidneys from a deceased donor are available a search for suitable recipients among all the Nordic actively waiting subjects is performed using the Scandiatransplant database. Table 1 illustrates where adding acceptable mismatches increased the number of acceptable antigens significantly. This procedure increases the likelihood to find a

Discussion

The STAMP program is up and running; several highly immunized kidney recipients have undergone successful transplantation and waiting times have been reduced. Because the data are still limited and the observation times in many cases are short, we need a closer, more detailed follow-up. However, the transplantation results were acceptable; alternatives must be used for recipients to address the marginally improved probability of transplantation and long waiting times on STAMP.

After the program

Acknowledgments

The collaboration with the STAMP steering committee (Bjarne Møller, Mats Bengtson, Jouni Lauronen, Christian Naper, Torbjørn Leivestad [former member of the STAMP committee]), Lars Wennberg, and Lauri Kyllönen) is greatly appreciated. The work made by the rest of the team at the Scandiatransplant office (Christian Mondrup, Bo H. Pedersen, Susanne Sønder, Camilla Pedersen, and Tito Phiri) is gratefully acknowledged. Transplantation coordinators, laboratory technicians, secretaries, nurses, and

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