Providing Better-Matched Donors for HLA Mismatched Compatible Pairs Through Kidney Paired Donation
Providing Better-Matched Donors for HLA Mismatched Compatible Pairs Through Kidney Paired Donation
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DOI：
10.1097/tp.0000000000001196
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发表时间：
2017-03-01
期刊：
影响因子：
6.2
通讯作者：
Holdsworth, Rhonda
中科院分区：
文献类型：
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作者：
Ferrari, Paolo;Cantwell, Linda;Holdsworth, Rhonda
背景相容配对(CP)参与肾配对捐献(KPD)，如果配对配对受者获得较好的配型，则可能对具有高度相合程度的CP具有吸引力。由于KPD计划不是为了帮助CP而设计的，因此重要的是定义分配指标，使CP能够获得更匹配的肾脏，而不会对不相容配对(ICP)不利。方法使用澳大利亚的KPD匹配算法对46个ICP和11个完全不相合的CP进行模拟。分配是一次添加1个CP或同时添加所有11个CP，并在排除和不排除不可接受的抗原的情况下选择，以提供70%至80%的虚拟计算群反应抗体，以改善CP接受者的人类白细胞抗原配型。结果平均而言，大多数CP受者可以配型，与供者配型的EPMM(57+/-15)低于自身供者的EPMM(78+/-19，P<；0.02)。然而，只有EPMM与供者之比大于65的受者与配对供者的EPMM显著降低。当CP被列为不可接受的抗原时，EPMM的收益更大。此外，一次包含1个CP可使配型增加33%，同时包含全部11个CP可使配型增加50%。结论相容配对参与KPD可提高妊娠肝内胆汁淤积症的匹配率，且在基于虚拟交叉匹配的分配方式下，对于EPMM较高的CP受者，可提供更好的免疫学特征。
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.