Abstract
Purpose: The accumulation of highly sensitized patients (HSP) on renal transplant waiting lists is a universal problem and finding donors for them represents a major challenge for organ distribution organizations. The purpose of this report is to describe a possible Brazilian version of the Eurotransplant Acceptable Mismatch program and the results of a study performed to test its efficiency. Method: The acceptable mismatches were defined with the single antigen beads Luminex assay, each test being individually interpreted with aid of the HLAMatchmaker algorithm. Negative-crossmatch prediction was validated in 86 T cell crossmatches using complement dependent cytotoxicity with anti-human globulin. Results: The estimation of the chances of 40 HSP to find a donor through the program showed that about 70% of them would be offered an ABO compatible, zero HLA-DR mismatched, T and B cell crossmatch negative graft within a two-year period after joining the program. On the other hand, for about 30% of the patients, the chances to find a suitable donor would be minimal, even after three or five years. Conclusions: We estimated that around 70% of the HSP would clearly benefit from the algorithm proposed in this study. On the other hand, those patients for whom it would be highly improbable to find a compatible donor would be primary candidates for desensitization/antibody reduction protocols. Therefore, we concluded that the information regarding the transplantability of each HSP provided by the algorithm herein described is a powerful tool for a proper management of highly sensitized patients in regional, national and international organizations as to deceased donor kidneys distribution.
Highlights
Sensitized patients (HSP) tend to accumulate on waiting lists for renal transplantation because they have a low probability of finding a negative crossmatch organ via standard allocation procedures
In order to enhance the chances of Highly sensitized patients (HSP) finding a suitable donor, we propose the utilization in Brazil, of a program similar to the Acceptable Mismatch (AM) Program being use in Eurotransplant, in which the highest priority is given to HSP as soon as a compatible donor with the patient’s antibody profile becomes available. 3-6 Here, we describe an algorithm intended to be initially used in the State of São Paulo, and afterwards to be adapted for implementation in other states or regions in Brazil
In almost every case (94.9%) beads corresponding to these 59 AMs showed reactions in the single antigen assay with lower than 1,500 nMFI, with 88.1% of beads presenting lower than 500 nMFI reactions
Summary
Sensitized patients (HSP) tend to accumulate on waiting lists for renal transplantation because they have a low probability of finding a negative crossmatch organ via standard allocation procedures. Performing crossmatches with every available ABO compatible blood group deceased donor has been implemented in some organ allocation programs,[1,2] but this proved to be a method of limited efficiency and a time-consuming procedure, often leading to an increase in cold ischemia time. More than 40% of the deceased donors kidney transplants were performed in the State of São Paulo (Registro Brasileiro de Transplantes, Ano XV, 4, 2009) where the deceased donors kidney allocation system is based on HLA-A, B and DR compatibility, in two tiers. All recipients on the waiting list (approximately 10,000 individuals) are considered for an ABO compatible and zero HLA-A, B, DR mismatched donor. The second tier considers patients from one of JBT J Bras Transpl. 2010; 13:1221-1280
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