Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation

Ferrari, Paolo; Fidler, S.; Wright, Jenni; Woodroffe, Claudia; Slater, Paul V.; Althuis-Jones, A. Van; Holdsworth, Rhonda; Christiansen, Frank

doi:10.1111/j.1600-6143.2010.03313.x

Cited by 42 publications

(57 citation statements)

References 25 publications

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“…However, considerable controversy remains regarding the best practices for accomplishing this goal (15)(16)(17)22,23). This report demonstrates that virtual crossmatches can be used to reliably predict acceptable cell-based crossmatches and a large number of transplants can be achieved by allowing each transplant center to establish criteria for assigning unacceptable antigens and acceptable crossmatches.…”

Section: Discussionmentioning

confidence: 95%

“…Importantly, this high rate of accurate virtual crossmatches was achieved without conservative strategies that have been proposed by others, such as establishing common parameters for unacceptable antigens and acceptable crossmatches or employing a central laboratory (15,16).…”

Section: Successful Virtual Crossmatching For Kpdmentioning

confidence: 99%

“…For example, the Australian National Exchange program used 2000 MFI to assign unacceptable antigens, but no compatible donors were identified in four quarterly match runs (16,22,23). The likelihood of a match was improved by increasing the threshold to 8000 MFI, but patients with even higher levels of DSAs can be successfully transplanted (18,19).…”

Section: Successful Virtual Crossmatching For Kpdmentioning

confidence: 99%

See 2 more Smart Citations

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

Baxter‐Lowe

Cecka

Kamoun

et al. 2014

American Journal of Transplantation

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Multi‐center kidney paired donation (KPD) is an exciting new transplant option that has not yet approached its full potential. One barrier to progress is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients. Virtual crossmatch results from a large multi‐center consortium, the National Kidney Registry (NKR), were analyzed to determine the effectiveness of flexible center‐specific criteria for virtual crossmatching. Approximately two‐thirds of the patients on the NKR waitlist are highly sensitized (>80% CPRA). These patients have antibodies against HLA‐A (63%), HLA‐B (66%), HLA‐C (41%), HLA‐DRB1 (60%), HLA‐DRB3/4/5 (18–22%), HLA‐DQB1 (54%) and HLA‐DPB1 (26%). With donors typed for these loci before activation, 91% of virtual crossmatches accurately predicted an acceptable cell‐based donor crossmatch. Failed virtual crossmatches were attributed to equivocal virtual crossmatches (46%), changes in HLA antibodies (21%), antibodies against HLA‐DQA (6%), transcription errors (6%), suspected non‐HLA antibodies (5%), allele‐specific antibodies (1%) and unknown causes (15%). Some failed crossmatches could be prevented by modifiable factors such as more frequent assessment of HLA antibodies, DQA1 typing of donors and auditing data entry. Importantly, when transplant centers have flexibility to define crossmatch criteria, it is currently feasible to use virtual crossmatching for highly sensitized patients to reliably predict acceptable cell‐based crossmatches.

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Section: Discussionmentioning

confidence: 95%

Section: Successful Virtual Crossmatching For Kpdmentioning

confidence: 99%

Section: Successful Virtual Crossmatching For Kpdmentioning

confidence: 99%

See 1 more Smart Citation

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

Baxter‐Lowe

Cecka

Kamoun

et al. 2014

American Journal of Transplantation

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“…The precise evaluation of HLA antibodies present in sera of sensitized patients coupled with objective identification of the HLA antigens expressed by organ donors defined the process of the vXM. The implementation of the vXM has facilitated local, regional and national solid organ allocation from both deceased and living donors (13,(15)(16)(17)(18) and has been particularly beneficial to highly sensitized patients, that is, those with panel reactive antibody (PRA) !80%.…”

Section: Revolutionmentioning

confidence: 99%

HLA Antibody Detection With Solid Phase Assays: Great Expectations or Expectations Too Great?

Gebel

Bray

2014

American Journal of Transplantation

134

101

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Alloantibodies directed against HLA antigens, are a barrier to long-term solid organ allograft survival. The clinical impact of preformed, donor-directed HLA alloantibodies range from acceptable risk to unequivocal contraindication for organ transplantation. HLA antibodies are key factors that limit patient access to donor organs. Serological methods were once the only approach to identify HLA antigens and antibodies. Limitations in these technologies led to the development of solid phase approaches. In the early 1990s, the development of the polymerase chain reaction enabled DNA-based HLA antigen testing to be performed. By the mid-1990s, microparticle-based technology that utilized flow cytometry for analysis was developed to detect both classes I and II HLA antibodies. These methodologies revolutionized clinical histocompatibility testing. The strengths and weaknesses of these assays are described in detail in this review.

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“…Only those patients whose HLA antibodies are not donor directed will appear on the matching run (negative virtual crossmatch). Virtual crossmatch is increasing used in clinical practice as this has improved the efficiency of organ allocation by decreasing the risk of positive crossmatch and cold ischaemia time [76,77].…”

Section: Crossmatchmentioning

confidence: 99%

Immunology for Renal Transplantation: A Review

Shrestha¹

2013

J Transplant Technol Res

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The current success of renal transplantation (RT) is the result of advancement in the understanding of the transplant immunology from gross allograft rejection to cellular and antibody response to the current molecular level. Laboratory assay technologies have been developed to characterise patient sensitisation and to detect pre-existing donor-specific antibodies (DSA) in pre-transplant crossmatch, which has helped prevent premature transplant losses from early and late antibody-mediated rejection. After a RT, pre-existing or de novo DSA are routinely monitored for modulation of immunosuppressive regimens. Therefore, it is mandatory for the personnel involved in the management of RT recipients to have clear understanding of the components of transplantation immunology and be familiar with the modern immunological techniques used in RT.

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Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation

Cited by 42 publications

References 25 publications

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

HLA Antibody Detection With Solid Phase Assays: Great Expectations or Expectations Too Great?

Immunology for Renal Transplantation: A Review

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