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Providing Better-Matched Donors for HLA Mismatched Compatible Pairs Through Kidney Paired Donation

Ferrari, Paolo MD; Cantwell, Linda BSc; Ta, Joseph BSc; Woodroffe, Claudia RN; D'Orsogna, Lloyd PhD; Holdsworth, Rhonda BSc

doi: 10.1097/TP.0000000000001196
Original Clinical Science-General

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.

Compatible pairs (CP) participation in kidney paired donation can increase match rates in incompatible pairs and can provide a better immunological profile in CP recipients who have a high eplet mismatch to their own donor when using allocation based on virtual crossmatch.

1 Department of Nephrology and Transplantation, Prince of Wales Hospital, Sydney, NSW, Australia.

2 Clinical School, University of New South Wales, Sydney, Australia.

3 Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.

4 Department of Clinical Immunology, Fiona Stanley Hospital, Mudroch, WA, Australia.

5 School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.

Received 10 December 2015. Revision received 10 February 2016.

Accepted 12 February 2016.

Funded by the Centre for Market Design, Melbourne University.

The authors of declare no conflicts of interest.

P.F. participated in data analysis, performance of the research and writing of the article. L.C. participated in data analysis, performance of the research and writing of the article. J.T. participated in data analysis and performance of the research. C.W. participated in data analysis, performance of the research. L.D.O. participated in data analysis, performance of the research. R.H. participated in data analysis, performance of the research.

Correspondence: Paolo Ferrari, MD, Department of Nephrology and Transplantation Clinical School, University of New South Wales Prince of Wales Hospital, High Street, Randwick, Sydney NSW 2031, Australia. (paolo.ferrari@sesiahs.health.nsw.gov.au).

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