Would eplet matching change the allocation of deceased donor kidneys to unsensitised renal transplant recipients?

Background: It is suggested that donor/recipient matching at the structural epitope level (i.e. amino acid sequence known as eplets) may better predict rejection, graft survival and development of anti-human leukocyte antigen (HLA) antibodies compared to broad HLA-antigen matching following kidney transplantation. Broad antigen mismatch with 0-2 eplet mismatches identified using HLAMatchmaker is considered an acceptable mismatch (AM) at the structural level. Aim: To determine whether the inclusion of AM would change the allocation of deceased donor kidneys to unsensitized recipients in Western Australia (WA). Methods: Unsensitized (defined as panel reactive antibodies < or =2096) renal transplant recipients who had received deceased-donor kidneys in WA from January to December 2011 were included. Allocation scores and rankings were recalculated for historical matches with inclusion of AM to determine potential reductions in waiting time. Results: We identified 420 pairs (47 recipients). Results are shown in Table 1. If AM were considered, 34% (16/47) of patients would have improved to levels 1-4 ranking with 28% (15/47) being offered a kidney, reducing waiting time by a mean (SD) of 15 (10) months. Conclusions: Inclusion of AM in the allocation of deceased-donor kidneys would reduce the waiting time for up to 30% of unsensitised recipients.