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Selected Works of Sally Lord
Article
The relative benefits and costs of solid phase bead technology to detect preformed donor specific antihuman leukocyte antigen antibodies in determining suitability for kidney transplantation
Transplantation (2015)
  • Hung T. Do Nguyen, The University of Western Australia
  • Wai H Lim, The University of Western Australia
  • Jonathan Craig, The University of Sydney
  • Jeremy R Chapman, The Childrens Hospital at Westmead
  • Sally Lord, The University of Notre Dame Australia
  • Kirsten Howard, The University of Sydney
  • Germaine Wong, The University of Sydney
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Abstract
Background. Screening for donor-specific anti-HLA antibodies (DSA) using bead-based multiplex assays to determine transplant
suitability is standard practice in many countries. We compared the health benefits and costs of screening preformed DSA
using bead-based assay as an add-on test to complement-dependent cytotoxicity (CDC) crossmatch with CDC crossmatch
alone, and determined the optimal threshold to determine transplant suitability. Methods. Three probabilistic Markov models
were developed to compare bead-based assay with CDC and CDC alone. The model assumed a hypothetical cohort of
10,000 patients who received only a single kidney transplant and terminated when all patients were deceased. Results. Assuming
transplantation was permitted for recipients with no DSA or with a DSA mean fluorescence intensity (MFI) value of 500 or less,
screening by bead-based assay and CDC saved 6.5 grafts and U.S. $1,192,303 per 100 transplants compared with CDC alone. If
the thresholds were increased to an MFI of 2000 or less and 5000 or less, an extra 6.4 and 6.1 grafts would be saved, with cost
savings of U.S. $867,203 and U.S. $830,664 per 100 transplants compared with CDC alone. The total number of kidney transplants
performed would have increased by 8 and 9, respectively, but at the expense of an extra 0.1 and 0.4 graft lost per
100 transplants after 5 years. Conclusions. Screening using bead-based assay is cost-saving and improves graft outcomes.
The greatest benefits and cost-savings are achieved if transplantation occurs at a threshold of MFI of 500 or less or in those
without preformed DSA. Increasing the threshold to an MFI of 2000 or less may provide an acceptable balance for improving
transplant eligibility without compromising longer-term outcomes.
Disciplines
Publication Date
2015
DOI
10.1097/TP.0000000000000697
Citation Information
Nguyen, H., Lim, W., Craig, J., Chapman, J., Lord, S., Howard, K., and Wong, G. (2015). The relative benefits and costs of solid phase bead technology to detect preformed donor specific antihuman leukocyte antigen antibodies in determining suitability for kidney transplantation. Transplantation, 99(5), 957-964. DOI: 10.1097/TP.0000000000000697