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• W1983347567 abstract "79 Most intestinal graft losses are now immunologic. We conducted a pilot study to evaluate the feasibility of a national sharing arrangement for HLA no-mismatch allografts for cadaveric isolated intestinal transplantation. Methods: Data from the UNOS/OPTN scientific registry were retrospectively analyzed. In a theoretical model, all solid organ donors from between 1/95-8/97 who would have met criteria for bowel donation were considered to be potential donors for all recipients who actually received isolated intestinal transplants during the same period. We then attempted to determine how many donor intestines could have been directed to no-mismatch candidates on the waiting list had national sharing been in place. Donor exclusion criteria were CMV+ donors to CMV-recipients, hemodynamic instability, age >50, size mismatch, and obesity. Mean and median waiting times for the actual transplants, as well as theoretical mean and median waits for transplants that would have occurred given a national sharing arrangement, were calculated. We further estimated the number of intestinal transplants that would be necessary to demonstrate a graft survival advantage with such sharing, based on Schoenfeld's formula. We estimated the number of transplants needed and the corresponding accrual period necessary to document a 10% graft survival advantage at 2 years with no-mismatch grafts. Results: Recipient and donor data were available on 47 cadaveric isolated intestinal transplants. The table shows the possible distribution of no-mismatch transplants given different donor exclusive criteria.TableWe then estimated the number of intestinal transplants with such allografts that would be necessary to demonstrate an advantage of HLA matching. On the basis of international registry graft survival data, assuming a 20% rate of no-mismatch cases and a survival advantage of 10% at 2 years, approximately 800 transplants would be required. At the current rate of transplantation, this would likely take approximately 10 years. If the graft survival advantage were 20% at 2 years, the time to show significance would be approximately 5 years. Conclusions: National sharing of cadaveric isolated intestinal allografts is feasible. Under such a system, median waiting time would not be significantly increased for recipients of no-mismatch allografts. The time to prove significance for graft survival advantage would be considerable at the present rate of intestinal transplantation. However, a national sharing arrangement, if acceptable to intestinal transplant centers, might improve overall outcomes of intestinal transplantation." @default.
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• W1983347567 date "1998-10-01" @default.
• W1983347567 modified "2023-09-23" @default.
• W1983347567 title "THE FEASIBILITY OF NATIONAL SHARING OF CADAVERIC ISOLATED INTESTINAL ALLOGRAFTS FOR HUMAN TRANSPLANTATION" @default.
• W1983347567 doi "https://doi.org/10.1097/00007890-199810270-00109" @default.
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