Prediction of negative crossmatch: an aid for cost-effective kidney sharing

Prospective kidney transplant recipients, who have broadly reactive cytotoxic antibodies, are currently at a considerable disadvantage in competing for shared kidneys since they tend not to be considered as candidates because of the likelihood of kidney wastage subsequent to positive crossmatch tests. Alternative to extensive shipping, storage and crossmatch testing by the harvesting center, is the prediction of crossmatch outcome on the basis of donor HLA type and recipient sera characteristics. A prediction method was developed that yields approximately 85% correct predictions. The method was validated by predicting crossmatch outcome of 67 consecutive cadaveric donors tested against 87 recipients and is suggested as useful for guiding kidney sharing programs.