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September 11, 1987

Selection of Kidney Recipients-Reply

JAMA. 1987;258(10):1328-1329. doi:10.1001/jama.1987.03400100062012

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In Reply.—  Drs Matas and Tellis merely have extended our argument that waiting time and other factors should be given more weight than antigen matching for kidney allocation. However, we do not believe that matching should be ignored altogether and for that matter neither do Matas and Tellis, as witnessed by their acceptance of six-antigen (full-house) matching.Their seemingly inequitable scenario is based on "nonsense" data. When a highly sensitized patient finally achieves a negative cross match, it is almost always found that good antigen matching also has been achieved, particularly at the A and B loci. If not, either the cross match test or the antigen typing is apt to be an error.Thus, it is not credible that their longest-waiting patient, with a 99% PRA, should have had only one antigen match, whereas it is understandable that their highly sensitized patients who had waited for nine and eight