Effect of Changing the Priority for HLA Matching on the Rates and Outcomes of Kidney Transplantation in Minority Groups

In the United States, proportionately more white patients than nonwhite patients who are on waiting lists for transplantation receive a renal transplant. This study compared the rates of transplantation among various racial and ethnic groups with the use of the current allocation policy, a policy in which HLA-B matching was eliminated as a priority, and a policy in which both HLA-B and DR matching were removed as priorities. Removing HLA-B matching as a priority could reduce the existing racial imbalance by increasing the number of nonwhites who receive a transplant, with only a small increase in graft loss. Racial and ethnic parity would be encouraged by changing the policy on HLA-B matching. The matching of histocompatibility antigens between donors and recipients improves the outcomes of kidney transplantation. 1 Matching provides the greatest advantage when the donor and the recipient have no antigens mismatched or when matching is identical at all six HLA loci. However, lesser degrees of matching still offer some advantage. 2 , 3 The current allocation policy for cadaveric kidneys in the United States gives priority to candidates who have no mismatches at any of the loci (zero mismatches) on a national basis and candidates who have zero, one, or two mismatches at the HLA-B and DR loci on a local, regional, and . . .