title: Should epitope-based HLA compatibility be used in the kidney allocation system?
abstract: The new kidney allocation system (KAS) still applies donor-recipient HLA compatibility mostly at the antigen level and although some four-digit alleles have been included. This system is used to record unacceptable mismatches for sensitized transplant candidates with serum HLA antibodies. Since the reactivities of such antibodies are specifically associated with epitopes rather than HLA antigens, a more scientifically accurate assessment of mismatch acceptability could be based on epitopes. HLA class I and class II epitope specificity analyses can now be readily performed with serum antibody assays with single allele panels. This report describes an epitope-based HLA compatibility system for KAS and involves recipient and donor HLA typing at the four-digit allele level. It focuses on sensitized patients who have serum antibodies specific for HLA epitopes that can be entered as unacceptable mismatches in the transplant candidate database. Newly developed software programs could readily identify compatible HLA types.
authors: University of Pittsburgh Medical Center, Pittsburgh, PA, United States. Electronic address: Duquesnoyr@upmc.edu.
authors: Rene J
authors: RJ
authors: Duquesnoy
mesh_terms: D000483:Alleles; D000906:Antibodies / Q000378:metabolism; D000939:Epitopes / Q000235:genetics / Q000276:immunology / Q000378:metabolism*; D033161:Government Regulation; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology / Q000378:metabolism*; D006648:Histocompatibility; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D012984:Software; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D014481:United States
chemical_list: D000906:Antibodies; D000939:Epitopes; D006680:HLA Antigens
keywords: Antibody; Epitope; Eplet; HLA; HLAMatchmaker; Mismatch acceptability; Transplantation