Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation

被引:39
作者
Ferrari, P. [1 ,2 ,3 ]
Fidler, S. [3 ,4 ,5 ]
Wright, J. [6 ]
Woodroffe, C. [1 ,3 ]
Slater, P. [6 ]
Van Althuis-Jones, A. [6 ]
Holdsworth, R. [7 ]
Christiansen, F. T. [4 ,5 ]
机构
[1] Fremantle Hosp, Dept Nephrol, Perth, WA, Australia
[2] Univ Western Australia, Sch Med & Pharmacol, Nedlands, WA 6009, Australia
[3] Australian Paired Kidney Exchange Program, Perth, WA, Australia
[4] Royal Perth Hosp, Dept Immunol, Perth, WA, Australia
[5] Univ Western Australia, Sch Pathol & Lab Med, Perth, WA 6009, Australia
[6] Australian Red Cross Blood Serv, Natl Organ Matching Serv, Sydney, NSW, Australia
[7] Australian Red Cross Blood Serv, Med Transplantat & Qual Serv Div, Melbourne, Vic, Australia
关键词
ABO; computerization; HLA; incompatibility; kidney transplantation; matching; paired kidney donation; LIVING DONOR POOL; HLA ANTIBODIES; ALLOGRAFT RECIPIENTS; EXCHANGE PROGRAM; TRANSPLANTATION; EXPERIENCE; REJECTION; REGISTRY; EXPAND; LEVEL;
D O I
10.1111/j.1600-6143.2010.03313.x
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
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.
引用
收藏
页码:272 / 278
页数:7
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