Abstrakt
Kidney pair donation (KPD) is one of a few efficient strategies to improve the chance of receiving a compatible kidney for patients with incompatible living kidney donor. Czechia is involved in an international KPD together with Austria (since 2016) and Israel (since 2019), where the Prague transplant center is the coordinating center for these exchanges.
In 2020 we developed a software called TXMatching to simplify the process of finding optimal matching between donor recipient pairs, especially for sensitized patients.
There are two key features of the tool. First, it supports calculation of HLA matching and virtual crossmatching for both high and low resolution typing. This includes a novel algorithm that determines whether the reactivity of an antibody is against the alpha or beta chains of DQ and DP. Second, it allows broad customization to accommodate the needs of all the countries and pairs. This includes recipient's MFI cutoff or acceptance criteria for donor (blood group, weight, age etc.). Moreover, when calculating the optimal solution, maximum sequence length, debt between centers, HLA scorers and other parameters are configurable.
The software runs as a web application and is fully accessible from any PC or mobile device. The design ensures that the app is easy to use and at the same time gives each transplant center full control over their patients and donors.
As proof that the software is useful, we present a case study of an immunologically complicated patient actively waiting for 5 years for his second kidney transplantation in both KPD and deceased donor programs that found compatible kidney on the first attempt with the new algorithm. This donor would have been rejected based on two antibodies that would have been considered donor-specific if the virtual crossmatch was not performed on a high resolution and no discrimination was made between DQA and DQB reactivity. The patient is now 18 months since transplant without any rejection incidents.