Description of the Process of Inclusion and Kidney Transplantation Waiting List - Uruguay

Introduction: In Uruguay with 3,286,314 inhabitants (2011 census), renal transplantation is performed in 3 transplant centers, is regulated by the Instituto Nacional de Donación y Trasplante (INDT) and financed by the Fondo Nacional de Recursos. The allocation is made on a national algorithm and it is an INDT´s responsibity. In the last 5 years, including the Health Emergency, an average of 139 kidney transplants were performed per year. The average rate for these 5 years of renal transplantation is 42.33 pmp. Objective: Describe the renal waiting list (WL) admission process and the recipient population. Methods: The study algorithm for admission to the WL include: □ABO and Rh blood group typing. □HLA typing by PCR-SSO (Luminex) for A, B, C, DRB1, DQA1 and DQB1 locus. □HLA antibody screening (Luminex), class I and/or II. If positive, a specificity search is performed. □Search for autoantibodies by microlymphocytotoxicity technique (MLCT). □Patient’s serum is preserved (serum collection). □PRA (wall reactive antibodies) by MLCT, defining hyperimmunized PRA>80%. During the period in WL the following procedures are performed: □serum collection update every 3 months or after sensitizing events. Failure to comply with this requirement excludes recipients from the allocation. □HLA antibody screening and specificity analysis are performed annually and PRA every six months. Results: There are currently 434 patients in the WL, including one vascular emergency. Distribution - by age: 1.8% <18 years old, 85% 18-64 years old and 13.2%>65 years old; by sex: 43.8% female, 56.2% male. Blood group distribution: 54% are 0.35% A, 8% B and 2% AB. The highest immunological risk group: 18%, who aspire to be retransplanted, 1.4% hyperimmunized. There are 26.5% with positive HLA antibody screening, see table and distribution in graphs. Conclusions: A single national protocol is applied at the inclusion on the WL. In the renal WL, the adult population (18 to 65 years old), blood group 0, with a male/female ratio of 1.3 prevails. The immune risk group does not present significant changes with respect to previous evaluations. The prevalence of sensitized to both classes and hyperimmunized is maintained.