title: Determination of unacceptable HLA antigen mismatches in kidney transplant recipients: recommendations of the German Society for Immunogenetics.
abstract: One of the major tasks of histocompatibility and immunogenetics laboratories is the pretransplant determination of unacceptable antigen mismatches (UAM) in kidney transplant recipients. In this procedure, human leucocyte antigen (HLA) specificities are defined against which the patient has circulating alloantibodies that are expected to harm the transplanted organ. Using the information on UAM and the potential donor's complete HLA typing, prediction of the crossmatch result, the so called 'virtual crossmatch', is possible. Currently, the laboratories are using different algorithms for the determination of UAM, and depending on the algorithm, more or fewer organ offers are excluded for patients with a similar antibody profile. In order to bring homogeneity into the allocation of organs to immunized patients in Germany, the German Society for Immunogenetics established, on the basis of current knowledge, recommendations for the determination of UAM. The UAM recommendations, which are thought to serve as a common tool for responsible physicians at different transplant centers, contain technical issues that need to be considered and are individualized for sensitized patients with a high or intermediate risk of antibody-mediated rejection. The present review contains these recommendations and puts them into perspective to current international practice.
authors.affiliation: Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Süsal
authors.affiliation: Institute for Transfusion Medicine and Immunohaematology, German Red Cross Baden-Württemberg-Hessen, Frankfurt am Main, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Seidl
authors.affiliation: Center for Transfusion Medicine and Cell Therapy, Charité Campus Virchow Klinikum, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schönemann
authors.affiliation: Institute for Transfusion Medicine, University of Essen, Essen, Germany.
authors.forename: F M
authors.initials: FM
authors.lastname: Heinemann
authors.affiliation: Laboratory for Immunogenetics and General, Visceral, Transplantation, Vascular and Thoracic Surgery, Campus Grosshadern Ludwig-Maximilians-University, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kauke
authors.affiliation: Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Gombos
authors.affiliation: Institute of Transfusion Medicine and Transplantation Immunology, University Clinics of Münster, Münster, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kelsch
authors.affiliation: Transplantation Programs, Clinics of City Cologne, Cologne, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Arns
authors.affiliation: Institute for Transfusion Medicine, Clinics of City Cologne, Cologne, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Bauerfeind
authors.affiliation: Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hallensleben
authors.affiliation: Medical Clinic III, JW Goethe University, Frankfurt am Main, Germany.
authors.forename: I A
authors.initials: IA
authors.lastname: Hauser
authors.affiliation: Internal Medicine Center, Clinic for Kidney and Hypertension Diseases, Hannover Medical School, Hannover, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Einecke
authors.affiliation: Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Blasczyk
mesh_terms: D005858:Germany; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007125:Immunogenetics; D016030:Kidney Transplantation / Q000379:methods*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical
chemical_list: D006680:HLA Antigens
keywords: human leukocyte antigen antibodies; kidney transplantation; organ allocation; unacceptable human leukocyte antigen mismatches; virtual crossmatch