Department of Nephrology, Fremantle Hospital, Perth, Western Australia.
Am J Transplant. 2011 Feb;11(2):272-8. doi: 10.1111/j.1600-6143.2010.03313.x. Epub 2010 Nov 10.
We developed and tested a new computer program to match maximal sets of incompatible live donor/recipient pairs from a national paired kidney donation (PKD) registry. Data of 32 incompatible pairs included ABO and 4 digit-high-resolution donor and recipient HLA antigens and recipient's HLA antibodies. Three test runs were compared, in which donors were excluded from matching to recipients with either donor-specific antibodies (DSA) >8000MFI (mean fluorescent intensity) at low-resolution (Run 1) or >8000MFI at high-resolution (Run 2) or >2000MFI and high-resolution (Run 3). Run 1 identified 22 703 possible combinations, with 20 pairs in the top ranked, Run 2 identified 24 113 combinations, with 19 pairs in the top ranked and Run 3 identified 8843 combinations, with 17 pairs in the top ranked. Review of DSA in Run 1 revealed that six recipients had DSA 2000-8000MFI causing a possible positive crossmatch resulting in breakdown of two 3-way and three 2-way chains. In Run 2, four recipients had DSA 2000-8000MFI, also potentially causing breakdown of three 2-way chains. The more prudent approach of excluding from matching recipients with DSA with >2000MFI reduces the probability of matched pairs having a positive crossmatch without significantly decreasing the number of possible transplants.
我们开发并测试了一种新的计算机程序，用于从全国性的配对肾脏捐赠 (PKD) 登记处匹配最大数量的不相容活体供体/受者对。数据包括 32 对不相容的供体和受者，其中包括 ABO 血型和 4 位高分辨率的供体和受者 HLA 抗原以及受者的 HLA 抗体。比较了三次测试运行，其中将供体排除在与具有低分辨率时供体特异性抗体 (DSA) >8000MFI（平均荧光强度）（运行 1）或高分辨率时供体特异性抗体 (DSA) >8000MFI（运行 2）或高分辨率时 DSA >2000MFI 的受者进行匹配（运行 3）。运行 1 确定了 22 703 个可能的组合，其中排名前 20 的组合有 20 对，运行 2 确定了 24 113 个组合，排名前 20 的组合有 19 对，运行 3 确定了 8843 个组合，排名前 20 的组合有 17 对。对运行 1 中的 DSA 进行审查后发现，六名受者的 DSA 为 2000-8000MFI，可能导致正交叉配型试验失败，从而导致三个三向和三个双向配型链破裂。在运行 2 中，四名受者的 DSA 为 2000-8000MFI，也可能导致三个双向配型链破裂。更为谨慎的方法是将 DSA >2000MFI 的受者排除在匹配之外，可以降低匹配对出现正交叉配型的可能性，而不会显著减少可能的移植数量。
