Department of Nephrology, Fremantle Hospital, Perth, Western Australia, Australia.
Transplantation. 2012 Oct 15;94(7):744-9. doi: 10.1097/TP.0b013e3182612967.
In kidney paired donation (KPD), flexibility in the allocation of incompatible pairs is required if a critical mass of pairs to efficiently find matches cannot be reached.
In the Australian KPD program, virtual crossmatch is used for the allocation of suitable donors to registered recipients. Matching is based on acceptable mismatches, and donors are excluded from matching to recipients with donor-specific antibodies (DSAs) greater than 2000 mean fluorescence intensity (MFI). Match and transplant rates in the first year of the program were reviewed with respect to recipient and donor characteristics, including blood group distribution, level of recipient's sensitization, and postallocation crossmatches.
Four quarterly match runs were performed, which included 53 pairs and 2 altruistic donors. Human leukocyte antigen incompatibility accounted for 90% of the listed pairs. In the second run, the DSA threshold was increased to greater than 8000 MFI, because no matches were found with standard allocation. Optional ABO-incompatible matching was introduced from run 3. Matches were identified in 37 (70%) patients, of whom 92% had a negative crossmatch with their matched donor. Crossmatch positive results were found only in recipients with DSAs greater than 2000 MFI in the second run. In 4 cases immunological reasons and in 4 cases other reasons resulted in breakdown of chains and 17 patients not progressing to transplantation. Eventually, 20 (38%) patients received a KPD transplant, and 35% of these had a calculated panel-reactive antibody greater than 90%.
KPD using virtual crossmatch is a valid and effective solution for patients with immunologically incompatible donors even in the context of highly sensitized recipients.
在肾对体捐赠（KPD）中，如果无法达到足以有效寻找配对的大量配对，那么需要灵活分配不兼容的配对。
在澳大利亚的 KPD 计划中，虚拟交叉配型用于为注册的受者分配合适的供者。配型基于可接受的错配，并且将供者排除在与供者特异性抗体（DSA）大于 2000 平均荧光强度（MFI）的受者匹配之外。根据受者和供者的特征，包括血型分布、受者致敏程度以及分配后交叉配型，回顾了该计划第一年的匹配和移植率。
进行了四次季度匹配运行，其中包括 53 对和 2 名利他供者。人类白细胞抗原不相容性占列出的配对的 90%。在第二次运行中，将 DSA 阈值提高到大于 8000 MFI，因为标准分配未找到匹配。从第 3 次运行开始引入了可选的 ABO 不相容匹配。在 37 名（70%）患者中确定了匹配，其中 92%的患者与匹配的供者交叉配型阴性。仅在第二次运行中 DSA 大于 2000 MFI 的受者中发现交叉配型阳性结果。在 4 例中，免疫原因和在 4 例中其他原因导致链中断，17 例患者未进展为移植。最终，有 20 名（38%）患者接受了 KPD 移植，其中 35%的患者计算的面板反应性抗体大于 90%。
即使在高度致敏的受者的情况下，使用虚拟交叉配型的 KPD 对于具有免疫不相容供者的患者也是一种有效且有效的解决方案。
