19. McKee M, Segev D, Wise B, et al. Initial experience with FK506 (tacrolimus) in pediatric renal transplant recipients. J Pediatr Surg 1997; 32 (5): 688. 20. Offner G, Latta K, Bokenkamp A, Hoyer PF. Tacrolimus for rescue of renal transplantation in children: the II Interna- tional Congress on Pediatric Transplantation, August 22–24 [Abstr. S18]. Pediatr Nephrol 1996; 10 (4): C62. 21. Carroll PB, Rilo H, Reyes J, et al. FK-506 associated diabetes mellitus in the pediatric transplant population is a rare com- plication. Transplant Proc 1991; 23: 3171. 22. Snydman DR (ed). Proceedings of a symposium on high-risk transplantation. Transplant Proc 1994; 26 (5) (Suppl 1): 45. 23. Delone P, Corkill J, Jordan M, et al. Successful treatment of Epstein-Barr virus infection with ganciclovir and cytomegalo- virus hyperimmune globulin following kidney transplantation. Transplant Proc 1995; 27 (5) (Suppl 1): 58. 24. Green M, Reyes J, Todo R, Rowe DT. Use of quantitative com- petitive PCR (QC-PCR) to guide preemptive therapy (PT) against EBV associated post-transplant lymphoproliferative disorders (PTLD) after intestinal transplantation (ITx) in chil- dren. Transplant Proc 1996; 28: 2759. 25. Filler G, Amendt P, Von Bredow MA, Ehrich JH. Transient diabetes mellitus and peripheral insulin resistance following tacrolimus intoxication in a child after renal transplantation. Nephrol Dialysis Transplant 1997; 12 (2): 334. 26. Shapiro R, Scantlebury VP, Jordan ML, et al. Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature. Transplant Proc 1997; 29 (6): 2737. 27. McCauley J, Takaya S, Fung J, et al. The question of FK506 nephrotoxicity after liver transplantation. Transplant Proc 1991; 23: 1444. 28. Starzl TE, Abu-Elmagd K, Tzakis A, Fung JJ, Porter KA, Todo S. Selected topics on FK506, with special references to rescue of extraheptic whole organ grafts, transplantation of “forbidden organs,” side effects, mechanisms, and practical pharmacoki- netics. Transplant Proc 1991; 23: 914. 29. Starzl TE. FK506 versus cyclosporine. Transplant Proc 1993; 25: 511. 30. Demetris AJ, Banner B, Fung JJ, Shapiro R, Jordan M, Starzl TE. Histopathology of human renal allograft function under FK506: a comparison with cyclosporine. Transplant Proc 1991; 23: 944. 31. Randhawa PS, Shapiro R, Jordan ML, Starzl TE, Demetris AJ. The histopathological changes associated with allograft rejec- tion and drug toxicity in renal transplant recipients main- tained on FK506: clinical significance and comparison with cyclosporine. Am J Surg Pathol 1993; 17: 60. 32. Shapiro R, Fung JJ, Jain AB, Parks P, Todo S, Starzl TE. The side effects of FK506 in humans. Transplant Proc 1990; 22 (1): 35. Received 19 May 1998. Accepted 13 August 1998. 0041-1337/99/6702-303$03.00/0 TRANSPLANTATION Vol. 67, 303–309, No. 2, January 27, 1999 Copyright © 1999 by Lippincott Williams & Wilkins Printed in U.S.A. A NEW ALLOCATION PLAN FOR RENAL TRANSPLANTATION 1 FRANCIS L. DELMONICO, 2 WILLIAM E. HARMON,MARC I. LORBER,JANE GOGUEN,HELEN MAH, JONATHAN HIMMELFARB,GEORGE LIPKOWITZ,SHAUNEEN VALLIERE,LAURINE BOW, EDGAR L. MILFORD, AND RICHARD J. ROHRER United Network for Organ Sharing Region 1 Renal Data Committee Background. A novel plan of renal allograft alloca- tion has been conducted by United Network for Organ Sharing Region 1 transplant centers since September 3, 1996, based upon HLA matching, time waiting, and population distance points. The objectives of this plan were to achieve a balance between increasing the op- portunity of renal transplantation for those patients listed with long waiting times and promoting local organ donor availability. Methods. A single list of candidates was formulated for each cadaver donor, assigning a maximum of 8 points for time waiting, a maximum of 8 points for population distance from the donor hospital, and HLA points based upon the degree of B/DR mismatch. Ad- ditional points were awarded to a cross-match-nega- tive patient with a panel-reactive antibody of >80%, and to pediatric patients. Results. The total number of kidneys transplanted to patients who had waited >3 years was 100 (46%), and to patients who had waited >2.5–3 years was 29 (13%). However, the total number of kidneys transplanted to patients with the maximum population distance points was only 72 (33%). Thus, although the plan achieved a favorable distribution of kidneys to pa- tients with longer waiting times (nearly 60%), the other, equally important objective of promoting local donor availability was not initially accomplished. Moreover, minor HLA B/DR differences between the donor and the recipient (i.e., not phenotypically matched) were unexpectedly consequential in deter- mining allocation. As a result of these observations, the following adjust- ments were made in the plan (as of December 3, 1997): a maximum of 10 points for population distance, a maxi- 1 Presented at the 24th Annual Meeting of the American Society of Transplant Surgeons, May 13–15, 1998, Chicago, IL. 2 Address correspondence to: Francis L. Delmonico, M.D., Medical Director, New England Organ Bank, One Gateway Center, Newton, MA 02458-2803. E-mail: francis_delmonico@neob.com. DELMONICO ET AL. January 27, 1999 303