Human leukocyte antigen antibody detection and kidney allocation within Eurotransplant

The human leukocyte antigen (HLA) antibody status of a patient on the waiting list is one of the parameters for the allocation of donor kidneys within Eurotransplant. The introduction of more sensitive solid phase assays in addition to the current gold standard, complement-dependent cytotoxicity, will have an obvious impact on the allocation provided that the results have the same value. However, in contrast to a positive complement-dependent cytotoxicity crossmatch because of donor HLA–specific antibodies, which is considered a contraindication for transplantation, antibodies detected in the solid phase are a risk factor rather than a contraindication. Furthermore, the higher sensitivity of Luminex-based screening assays, especially, will lead to a significantly higher number of highly sensitized patients and may affect the exclusivity of the acceptable mismatch program, which was initiated to give priority to highly sensitized patients. More data on the clinical relevance of antibodies detected by solid phase assays are necessary before their relevance for organ allocation can be established.