Abstract
Aim In November 2014, the OPTN/UNOS Board of Directors mandated that DPB1(DP) typing be performed for deceased donors (DD) predicated on data showing that a significant number of highly sensitized patients possessed antibodies to these antigens (AJT 15:284; 2015). Currently, there are >430 DP alleles but only 27 are represented on single antigen bead (SAB) products. Thus, for donor DP antigens that do not correspond to a SAB, a sensitized recipient’s compatibility cannot be easily determined. To address this problem, we developed a computer-assisted tool to assess donor:recipient (D/R) DPB1 compatibility. Methods We compared the amino acid (AA) sequence of D/R DP alleles to the AA sequence of DP alleles to which the recipient had antibodies as defined by SAB testing. Compatibility assessments were based on the 6 recognized hypervariable regions (HVRs A-F) for DPB1 (Tissue Antigens 75:278; 2010) associated with HLA antibodies. Based on this comparison, donor DP alleles were classified as “incompatible” or “likely compatible” using a custom Java web application. Results This software tool creates a static equivalency table for all DP alleles, classifying them based on similarity of the 6 HVRs. Furthermore, it specifically compares the D/R HVR AA sequences and renders an assessment of compatibility (Fig. 1). Conclusions Given the impending requirement for DP typing, we reasoned that a tool to predict D/R DP compatibility would be useful, particularly since there are far more DP alleles than present on any current SAB products. While the software tool successfully identified incompatible pairings, it was limited to differences in the 6 common HVRs; the tool was not designed to identify incompatibilities due to SNP differences between DP alleles sharing the same 6 HVRs. Nonetheless, we believe this tool will be an invaluable asset to organ allocation, readily identifying incompatibilities between donors and recipients for the 6 DP HVRs and, by extension, inferring when compatibility between donors and recipients is likely. Download : Download full-size image
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