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 anti...

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Bibliographic Details
Published in:American journal of transplantation 2011-02, Vol.11 (2), p.272-278
Main Authors: Ferrari, P., Fidler, S., Wright, J., Woodroffe, C., Slater, P., Van Althuis‐Jones, A., Holdsworth, R., Christiansen, F. T.
Format: Article
Language:English
Subjects:
ABO
Algorithms
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Clinical death. Palliative care. Organ gift and preservation
computerization
Directed Tissue Donation - statistics & numerical data
Histocompatibility Testing - methods
Histocompatibility Testing - statistics & numerical data
HLA
Humans
incompatibility
kidney transplantation
Kidney Transplantation - immunology
Kidney Transplantation - methods
Living Donors - statistics & numerical data
matching
Medical sciences
paired kidney donation
Software
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Tissue and Organ Procurement - methods
Tissue and Organ Procurement - statistics & numerical data
User-Computer Interface
Western Australia
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Summary: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. This study reports on the development and validation of a new computer program designed to optimally match incompatible live donor/recipient pairs and reduce the probability of matched pairs having a positive crossmatch. See editorial by Bingaman et al on page 194.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2010.03313.x