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Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation
Author(s) -
Ferrari P.,
Fidler S.,
Wright J.,
Woodroffe C.,
Slater P.,
Van AlthuisJones A.,
Holdsworth R.,
Christiansen F. T.
Publication year - 2011
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2010.03313.x
Subject(s) - medicine , donor specific antibodies , matching (statistics) , abo blood group system , human leukocyte antigen , high resolution , histocompatibility testing , antigen , immunology , pathology , remote sensing , geology
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.