Background: In Brazil (BZ), the kidney allocation policy for highly sensitized patients (HS) (PRA ≥ 80%) does not involve prioritization and transplants 10 times less HS patients as compared to non-HS individuals.

Aim: To implant, in the state of Pernambuco (PE), BZ, a new allocation strategy (KAPEVIX) to increase the chances of a kidney transplant in HS individuals, based upon the Epitope Virtual Crossmatch (EvXM) performed by the EpViX software.

Methods: Since October 2016, HLA typing and Single Antigen Beads assay (SAB) results from patients in renal transplant waiting list in PE were imported to EpViX. These data were screened for (1) preformed anti-HLA antibody epitope reactivity; (2) establishment of unacceptable mismatch and (3) performance of the EvXM at the time of kidney allocation. Whenever a deceased donor typed by PCR SSO for all loci was available and the BZ official program generated the rank of potential recipients, the EpViX derived from them a list of potential HS ones, all of which: with at least one HLA-DRB1 match, acceptable EvXM result (with no donor-specific antibody or with DSA against alleles with MFI < 5,000 carrying explainable epitope) and negative XM-CDC. All transplanted patients were induced with Thymoglobulin and post-transplant immunologic protocol monitoring accomplished with SAB. The rate of transplants, rejection and graft and patient were compared to that of the previous year under the KAPEVIX strategy.

Results: KAPEVIX strategy improved the transplant rate for HS in two times (OR = 2.0284; p = 0.0087) and stabilized their number in the waiting list, without negative impact on transplant rate for non-HS (p = 1.0). Besides, post-transplant follow-up shows high survival percentages for both, graft and patients (96% and 91% respectively).

Conclusion: The KAPEVIX strategy using the EpViX in PE-BZ was secure and effective to increase the number of transplants among HS patients in a public kidney transplant program for deceased donors.

CITATION INFORMATION: Sousa L., Silva A., Marroquim M., Coelho A., Lima A., Silva F., Carracosa C., Willcox G., Leão T., Correa B., Guimarães E., Maciel G., Andrade J., Andrade A., Neto R., Cavalcante S., Leão C., Cavalcante F., Holanda A., Gomes N., Rego A., Monte S. The Brazilian Epitope Virtual Crossmatch Protocol: A Reliable Tool for Increasing Kidney Allocation among Highly Sensitized Patients Am J Transplant. 2017;17 (suppl 3).

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