title: Providing Better-Matched Donors for HLA Mismatched Compatible Pairs Through Kidney Paired Donation.
abstract: Participation of compatible pairs (CP) in kidney paired donation (KPD) could be attractive to CPs who have a high degree of HLA mismatch, if the CP recipient will gain a better HLA match. Because KPD programs were not designed to help CP, it is important to define allocation metrics that enable CP to receive a better-matched kidney, without disadvantage to incompatible pairs (ICP).
  
  
  
  Simulations using 46 ICPs and 11 fully HLA-mismatched CPs were undertaken using the Australian KPD matching algorithm. Allocations were preformed adding 1 CP at a time or all 11 CPs at once, and with and without exclusion of unacceptable antigens selected to give a virtual calculated panel-reactive antibody ranging 70% to 80% to improve HLA matching in CP recipients.
  
  
  
  On average, most CP recipients could be matched and had a lower eplet mismatch (EpMM) with the matched donor (57 ± 15) than with their own donor (78 ± 19, P < 0.02). However, only recipients who had an EpMM to own donor greater than 65 achieved a significant reduction in the EpMM with the matched donor. The gain in EpMM was larger when CPs were listed with unacceptable antigens. Furthermore, inclusion of 1 CP at a time increased matching in ICP by up to 33%, and inclusion of all 11 CPs at once increased ICP matching by 50%.
  
  
  
  Compatible pair participation in KPD can increase match rates in ICP and can provide a better immunological profile in CP recipients who have a high EpMM to their own donor when using allocation based on virtual crossmatch.
authors.affiliation: 1 Department of Nephrology and Transplantation, Prince of Wales Hospital, Sydney, NSW, Australia. 2 Clinical School, University of New South Wales, Sydney, Australia. 3 Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia. 4 Department of Clinical Immunology, Fiona Stanley Hospital, Mudroch, WA, Australia. 5 School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
authors.forename: Linda
authors.initials: L
authors.lastname: Cantwell
authors.forename: Joseph
authors.initials: J
authors.lastname: Ta
authors.forename: Claudia
authors.initials: C
authors.lastname: Woodroffe
authors.forename: Lloyd
authors.initials: L
authors.lastname: DʼOrsogna
authors.forename: Rhonda
authors.initials: R
authors.lastname: Holdsworth
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000465:Algorithms; D001315:Australia; D015415:Biomarkers / Q000097:blood; D003198:Computer Simulation; D046148:Donor Selection; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D015234:HLA-A Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D015415:Biomarkers; D015234:HLA-A Antigens; D007518:Isoantibodies