Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation

• Published in: American journal of transplantation Vol. 11; no. 2; pp. 272 - 278
• Main Authors: Ferrari, P., Fidler, S., Wright, J., Woodroffe, C., Slater, P., Van Althuis‐Jones, A., Holdsworth, R., Christiansen, F. T.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.02.2011; Wiley
• 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; Western Australia; Incompatibility; HLA-System; ABO(H)-System; Major histocompatibility system; Homotransplantation; Kidney; ABO; matching; Organ donation; Blood group; Treatment; Urinary system; Surgery; Graft; Surgical approach; paired kidney donation; HLA; Histocompatibility; Class I histocompatibility antigen; Computerization; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2010.03313.x

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.