Current status of the Scandiatransplant acceptable mismatch program

This article describes the Scandiatransplant Acceptable Mismatch Program (STAMP), which was set into action in 2009. The aim of STAMP is to define human leukocyte antigens (HLA) toward which the potential kidney recipient has not developed antibodies, as "acceptable mismatches" in the Scandiatransplant database. In many cases this may improve the probability for a highly immunized recipient to receive a suitable kidney graft from a deceased donor. Using data extracted from the Scandiatransplant database on the outcomes of the program after the first 3 years, 31/115 recipients included in the program have undergone transplantation. From 2008 to 2011 the mean waiting time for highly immunized patients has decreased from 42 to 37 months. Continuous evaluation and follow-up of the program is essential to improve the procedures and outcomes. Calculation of transplantability based on a given set of acceptable mismatches was added to the program in 2011, based on the historical deceased donor pool providing the possibility of a specific patient to receive a kidney through STAMP. It is still a challenge for the tissue typing laboratories to determine which detected HLA antibodies are clinical relevant. We concluded that STAMP has had the intended effects, however adjustments and improvements is an ongoing process. As an improvment of the program HLA-C was added to the STAMP search algorithm in September 2012.