Can PIRCHE-II matching outmatch traditional HLA matching?
We analyzed in a cohort of 68,606 first deceased donor kidney transplantations reported to the Collaborative Transplant Study whether an epitope-based matching of donor-recipient pairs using the Predicted Indirectly ReCognizable HLA Epitopes algorithm (PIRCHE-II) is superior to the currently applied...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
26 February 2021
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| In: |
Frontiers in immunology
Year: 2021, Volume: 12, Pages: 1-9 |
| ISSN: | 1664-3224 |
| DOI: | 10.3389/fimmu.2021.631246 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3389/fimmu.2021.631246 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/articles/10.3389/fimmu.2021.631246/full 
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| Author Notes: | Christian Unterrainer, Bernd Döhler, Matthias Niemann, Nils Lachmann and Caner Süsal |
| Summary: | We analyzed in a cohort of 68,606 first deceased donor kidney transplantations reported to the Collaborative Transplant Study whether an epitope-based matching of donor-recipient pairs using the Predicted Indirectly ReCognizable HLA Epitopes algorithm (PIRCHE-II) is superior to the currently applied HLA antigen matching. PIRCHE-II scores were calculated based on split antigen HLA-A, -B, -DRB1 typing and adjusted to the 0-6 range of HLA mismatches. PIRCHE-II scores correlated strongly with the number of HLA mismatches (Spearman ρ=0.65, P<0.001). In multivariable analyses both parameters were found to be significant predictors of 5-year death-censored graft loss with high prognostic power (hazard ratio (HR) per adjusted PIRCHE-II score=1.102, per HLA mismatch=1.095; z-value PIRCHE-II: 9.8, HLA: 11.2; P<0.001 for both). When PIRCHE-II scores and HLA mismatches were analyzed simultaneously, their predictive power decreased but remained significant (PIRCHE-II: P=0.002; HLA: P<0.001). Influence of PIRCHE-II was especially strong in presensitized and influence of HLA mismatches in non-sensitized recipients. If the level of HLA-incompatibility was low (0−3 mismatches), PIRCHE-II scores showed a low impact on graft survival (HR=1.031) and PIRCHE-II matching did not have additional significant benefit (P=0.10). However, if the level of HLA-incompatibility was high (4−6 mismatches), PIRCHE-II improved the positive impact of matching compared to applying the traditional HLA matching alone (HR=1.097, P=0.005). Our results suggest the PIRCHE-II score is useful and can be included into kidney allocation algorithms in addition to HLA matching; however, at the resolution level of HLA typing that is currently used for allocation it cannot fully replace traditional HLA matching. |
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| Item Description: | Gesehen am 22.07.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1664-3224 |
| DOI: | 10.3389/fimmu.2021.631246 |