40-P

Abstract

Aim Current HLA Kidney Paired Donation (KPD) matching criteria may not always offer the best matched kidney that would result in minimum immunologic effects and maximal life of the transplanted organ. To optimize the KPD approach in anti-HLA sensitized patients, it would be best to match kidneys by identifying acceptable mismatches, ie, mismatches without immunologic consequences. A retrospective analysis for the improvement of optimal KPD matching in highly anti-HLA sensitized patients was performed by extending the matching criteria with the utilization of HLAMatchmaker. Methods Forty incompatible living donor pairs were used in this study. Inclusion criteria included (a) patient and donor recipient pairs that were incompatible due to ABO and/or positive flow crossmatch results, (b) patient cPRA of 50% or higher, (c) patients and recipients with allele-level HLA typing, and (d) patients with specific HLA antibody identification results. The incompatible donor-recipient pairs were analyzed for a local pilot KPD program using the IKx software. Acceptable donor-pairs were determined based on the avoidance of donor-specific antibodies (DSA). HLA antigen matching and the number of mismatched eplets were compared based on the optimal matches generated by current HLA matching criteria for KPD and by HLAMatchmaker alone. Results The results show that HLAMatchmaker generated a greater number (60%) of donor-recipient matches with low immunologic consequences as compared to current KPD matching criteria (26%). HLAMatchmaker allowed for 90% (36/40) of the recipients to be matched with a compatible donor and KPD allowed for 86% (35/40) compatible matched pairs. Conclusions The use of HLAMatchmaker in conjunction with current KPD algorithm for pairing patients and donors will result in low immunologic long-term kidney transplant outcomes.