Study: Eplet matching may be feasible for deceased donors
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Key takeaways:
- Of the candidates, 56% never matched to a low eplet mismatch kidney offer.
- At least one kidney from 70% of donors could be allocated to a candidate.
PHILADELPHIA — Kidney allocation based on eplet matching, which uses genetics to match a kidney donor to a transplant recipient, may be feasible without worsening disparities in transplant access, according to a speaker here.
In a study conducted at a multi-ethnic transplant center in British Columbia, researchers evaluated the ability of each waitlisted candidate from different ethnic groups to match a low eplet mismatch kidney offer. They also investigated whether incorporating eplet-based matching into deceased donor kidney allocation would open gaps in transplant access.
In conducting the study, researchers asked several key questions, Ross Doyle, MB, BCh, BAO, PhD, of the University of British Columbia, said in a presentation at the American Transplant Congress.
“What is unknown about eplets, for example, is if it is feasible to use eplets to allocate organs; and separately, if you could do that, would that disturb the [desired outcome]?” he said.
Investigators retrospectively analyzed consecutive deceased donor allocation for 3 months. Doyle and colleagues used high-resolution (human leukocyte antigens) HLA genotypes of donors and recipients to calculate eplet mismatches and find the proportion of organ offers with low eplet mismatches among ABO and HLA compatible active waitlisted candidates.
Overall, 52 deceased donors and 260 active waitlisted candidates were evaluated. Of the candidates, 39.9% identified as white, 17.9% as Asian, 16.8% as Asian-Indian, 11.3% as Filipino and 2.4% as Black.
Researchers discovered that, in 54% of donors, both kidneys could be allocated to candidates with low DR and DQ eplet mismatch, and at least one kidney from 70% of donors could be allocated to a candidate with low DR and DQ eplet mismatch. DR and DQ eplets represent specific amino acid configurations housed on the surface of an HLA molecule. Using eplet mismatch, more candidates were available to be allocated a low mismatched donor, Doyle said.
Investigators discovered a low eplet mismatch donor offer for both donor kidneys was possible for 57% of deceased donors. Additionally, within each allocation run, a median 14% of candidates had a low eplet mismatch kidney offer.
Of the candidates, 56% never matched to a low eplet mismatch kidney offer, with some being part of one or multiple low eplet mismatch offers. In the study group, 52% were never part of a low offer, 27% were part of one low offer and 21% were part of multiple low offers. Distribution of low eplet mismatch offers was similar among candidates from different ethnic groups, according to the Doyle and colleagues.
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Doyle R, et al. Poster 346. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
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