What is the Kidney for Life Initiative?
The Kidney for Life initiative utilizes a four-step process to derive the HLA eplet mismatch risk, which is a better predictor of de novo DSA than the antigen mismatch approach.
The Kidney for Life initiative utilizes the latest generation in DNA sequencing technology to assess the histologic match between patients and donors. This assessment allows our transplant centers to better select donors for specific recipients by better understanding the epitope mismatch risk between the donor and recipient. Epitope mismatch risk assessment is a more accurate matching technology than traditional antigen matching.[1]
After transplant, immunosuppressive medications keep the transplanted organ from being rejected. These immunosuppressive medications have side effects. Therefore, dosages should be appropriately minimized, when possible. Studies have shown that getting a low-risk match based on epitope mismatch risk assessment creates an opportunity to safely reduce immunosuppression dosages.[2]
Research Summary: Click the column header to access the research paper
| Variable | Eurotransplant | Canada | Canada | Belgium | Colorado |
|---|---|---|---|---|---|
| Year | 2017 | 2017 | 2019 | 2020 | 2020 |
| Sample Size | 2,787 | 596 | 664 | 926 | 444 |
| MFI Cutoff | 1,000 | 500 | 500 | 500 | 500 |
| % De Novo DSA | 15.8% | 11.0% | 12.4% | 4.6% | 18.5% |
| 1st Year DSA Timeframe | Unk | 0, 3, 12 months | 0, 3, 12 months | 0, 3, 12 months | 1, 6, 12 months |
| DSA Testing after 1 year | Every 12 months | Every 12 months | Every 12 months | Every 12 months | None |
| % Living Donor TXP | 22% | 48% | 49% | 5% | 47% |
| Alloimmunity Stratification | |||||
| High | 30% | 54% | 39% | 29% | 39% |
| Medium | 60% | N/A | 36% | 68% | 34% |
| Low | 10% | 46% | 25% | 3% | 27% |
The graphics below show the power of eplet matching in relation to the formation of de novo DSA. This matching capability is available through the National Kidney Registry’s paired exchange program and is not limited to incompatible pairs. Provided they are not six antigen matched sibling, compatible pairs will benefit greatly from this program as participation will ensure that they are transplanted with the best available living donor in the United States.
The graphic above utilizes data from the 2017 Canadian paper to show the effectiveness of eplet matching by comparing the incidence of de novo donor-specific antibodies (DnDSA) creation, a leading cause of organ rejection. As found by this study, a low risk mismatch after 10 years of follow-up showed virtually no DnDSA. In contrast, intermediate and high mismatches showed the formation of DnDSA regularly throughout the 10-year follow-up period.
The picture above utilizes data from a more recent study of a U.S. population of kidney transplants. This study used the same risk categories as the Canadian study and shows a similar pattern over the first 12 months of post-transplant follow-up. In this study, the one case in the low eplet mismatch category that developed DnDSA was due to the patient not adhering to their immuno-suppression protocol.