Virtual crossmatch approach to maximize matching in paired kidney donation.
We developed and tested a new computer program to match maximal sets of incompatible live donor/recipient pairs from a national paired kidney donation (PKD) registry. Data of 32 incompatible pairs included ABO and 4 digit-high-resolution donor and recipient HLA antigens and recipient's HLA antibodies. Three test runs were compared, in which donors were excluded from matching to recipients with either donor-specific antibodies (DSA) >8000MFI (mean fluorescent intensity) at low-resolution (Run 1) or >8000MFI at high-resolution (Run 2) or >2000MFI and high-resolution (Run 3). Run 1 identified 22 703 possible combinations, with 20 pairs in the top ranked, Run 2 identified 24 113 combinations, with 19 pairs in the top ranked and Run 3 identified 8843 combinations, with 17 pairs in the top ranked. Review of DSA in Run 1 revealed that six recipients had DSA 2000-8000MFI causing a possible positive crossmatch resulting in breakdown of two 3-way and three 2-way chains. In Run 2, four recipients had DSA 2000-8000MFI, also potentially causing breakdown of three 2-way chains. The more prudent approach of excluding from matching recipients with DSA with >2000MFI reduces the probability of matched pairs having a positive crossmatch without significantly decreasing the number of possible transplants.
Department of Nephrology, Fremantle Hospital, Perth, Western Australia. paolo.ferrari@health.wa.gov.au
P
P
Ferrari
S
S
Fidler
J
J
Wright
C
C
Woodroffe
P
P
Slater
A
A
Van Althuis-Jones
R
R
Holdsworth
F T
FT
Christiansen
D000465:Algorithms; D033001:Directed Tissue Donation / Q000706:statistics & numerical data*; D006650:Histocompatibility Testing / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods*; D019520:Living Donors / Q000706:statistics & numerical data; D012984:Software; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data; D014584:User-Computer Interface; D014904:Western Australia