Providing better-matched donors for HLA mismatched compatible pairs through kidney paired donation

P. Ferrari; L. Cantwell; J. Ta; C. Woodroffe; L. DʼOrsogna; R. Holdsworth

doi:10.1097/TP.0000000000001196

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Providing better-matched donors for HLA mismatched compatible pairs through kidney paired donation

Journal article

Peer reviewed

Providing better-matched donors for HLA mismatched compatible pairs through kidney paired donation

P. Ferrari, L. Cantwell, J. Ta, C. Woodroffe, L. DʼOrsogna and R. Holdsworth

Transplantation, Vol.101(3), pp.642-648

2017

DOI: https://doi.org/10.1097/TP.0000000000001196

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Abstract

BACKGROUND: 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). METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.

Details

Title: Providing better-matched donors for HLA mismatched compatible pairs through kidney paired donation
Authors/Creators: P. Ferrari (Author/Creator) - Australian Red Cross Lifeblood
L. Cantwell (Author/Creator) - Australian Red Cross Lifeblood
J. Ta (Author/Creator) - Australian Red Cross Lifeblood
C. Woodroffe (Author/Creator) - UNSW Sydney
L. DʼOrsogna (Author/Creator) - Fiona Stanley Hospital
R. Holdsworth (Author/Creator) - Australian Red Cross Lifeblood
Publication Details: Transplantation, Vol.101(3), pp.642-648
Publisher: Lippincott, Williams & Wilkins
Identifiers: 991005540352307891
Copyright: © 2016 Wolters Kluwer Health, Inc
Murdoch Affiliation: Murdoch University
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.157 Organ Donation & Transplantation; 1.157.1540 Antibody-Mediated Rejection
Web Of Science research areas: Immunology; Surgery; Transplantation
ESI research areas: Clinical Medicine