Strategies for Transplanting the Highly Sensitized Patient: Varying the Assignment of Unacceptable Antigens.
Nelson KA, Youngs D, Warner P.
Clinical Transplants 2007, Chapter 17
Expanding the pool of potentially compatible donors is one approach to improving access to transplantation for the sensitized candidate. The identification of unacceptable antigens and incorporation into UNet(sm) could form the basis for regional or national sharing. A rational approach using currently available assays can increase donor access for highly sensitized recipients. However, the limitations of the results and interpretations of these assays, and limitations in the types of data that can be entered into UNet(sm), affect the accuracy of predicting crossmatch outcome for highly sensitized candidates. It is possible to stratify UA based on the strength of antibodies in the single-antigen assays. Entering all antibody specificities as UA resulted in accurate prediction of compatible crossmatches. Entering only those UA associated with higher-tittered antibodies lowered the accuracy of predicting a compatible crossmatch. However, the combination of assigning fewer UA and performing more crossmatches per candidate provided transplants for sensitized individuals at a higher proportion, compared to assigning more UA that ruled out a larger number of donors.