A New UK 2006 National Kidney Allocation Scheme for Deceased Heart-Beating Donor Kidneys

Abstract

In 2004, it was agreed that a new allocation scheme for kidneys from deceased heart-beating donors was required in the United Kingdom to address observed inequities in access to transplant. The 2006 National Kidney Allocation Scheme (2006 NKAS) was developed to meet agreed objectives and preparatory work included a review of the criteria for human leukocyte antigen (HLA) matching and simulation evidence about the effectiveness of alternative schemes. ALGORITHM FOR 2006 NKAS: The 2006 NKAS gives absolute priority to all 000 HLA-A, -B, -DR-mismatched patients and well-matched pediatric patients (<18 years), and then a points score defines priorities for allocation with waiting time being most influential. Points for age and HLA mismatch are linked in a novel approach to ensure well-matched transplants for younger patients while recognizing that HLA matching is less important for older patients as retransplantation is less likely to be required. To improve equity for difficult to match patients, rare HLA specificities were defaulted to more common, related specificities. IMPACT OF 2006 NKAS: After 3 years, the scheme is already making good progress in achieving its objectives, with overall results similar to those observed in the simulations. There has been a significant benefit for patients waiting more than 5 years for transplant. A number of other advantages of the scheme are also apparent with equity of access improving in many respects, including the achievement of equity of access to transplant for HLA-DR homozygous patients, but geographical inequity of access will take a number of years to address fully.

Pediatric priority in kidney allocation: challenging its acceptability

“…This is largely explained by widespread noncompliance with the immunosuppressive regimen among adolescents [55]. 4 Given that there is a subgroup of adults with better outcomes than a subgroup of children, the prioritization of all pediatric age-groups seems untenable.…”

“…Scandiatransplant prioritizes pediatric recipients when a suitable HLA-matched kidney is available from a donor less than 40 years old [2]. Other European organ-sharing organizations, which accord priority to children, include the Agence de la Biom edecine and the NHSBT [3,4].…”

Good Cell Culture Practice for stem cells and stem-cell-derived models

“…ISCBI recommends performing HLA-typing, but does not prescribe specific guidelines on the resolution and loci that should be used for PSCs. Hematopoietic stem cell transplantations involve high resolution (Petersdorf, 2008) while solid organ transplants only require low resolution typing (Johnson et al, 2010;Dohler, 2007, 2010). PSC HLA haplotype banks currently utilize low resolution typing (Gourraud et al, 2012; Nakatsuji maintenance and storage of all cells and tissues, with regular monitoring for compliance.…”

In vivo studies on non-viral transdifferentiation of liver cells towards pancreatic β cells

“…However, the risks of lifelong immunosuppression (Matas et al 2004) and the paucity of organ donors (Daneman 2006, Johnson et al 2010 mean that allotransplantation cannot be regarded as a definitive therapy for type 1 diabetes. The possibility of xenogeneic pancreatic b cells for transplantation has not been realised, mainly because of the risks of interspecies viral transfer (Patience et al 1997, Cunningham et al 2004) and the vigour of the rejection response to xenografts (McGregor et al 2005).…”