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        The body makes millions of            Mary Keogan
        antibodies, which are primarily       (Consultant Immunologist)
        intended to fight off disease.        signing out the final cross
                                              match report
        However, when people have a
        blood transfusion, pregnancy,
        previous transplant or some
        infections, they can produce so-
        called ‘HLA antibodies’ which
        react with donor tissue and
        possibly damage it.
           We are aware that if we give a
        transplant to somebody that has
        HLA antigens, against which
        they have HLA antibodies, there
        is a higher risk of the kidney      difficulty finding a suitable       effective strategies to take
        failing due to rejection. It is     kidney donor  and will most         away antibodies that give
        therefore preferable to find a      likely have a prolonged wait on     good long-term results.
        kidney against which you do         dialysis. If the recipient has a       The levels of antibodies in the
        not have antibodies.                sibling, who is a ‘perfect match’,  recipient might fluctuate, and so
           You will hear the doctor talk    then antibodies are generally not   it may be possible that the initial
        about  PRA  or PGEN. This is a      important.     However,     even    screening for donor specific
        measure of the probability of       patients with 100% PRA can be       antibodies is favourable but, later
        having antibodies against 1,000     transplanted if the right donor     screening in the donor workup
        Irish donors; it is a measure of    comes along.                        shows that the donor is not
        how hard it will be to find a          When the recipient sees the      suitable.   This    can    cause
        suitable compatible donor. If the   transplant surgeon, at the pre-     significant disappointment to the
        recipient has a PGEN of 0% then     transplant assessment clinic,       donor who may be in an
        they have no antibodies and         they will be told what their PGEN   advanced stage of the workup
        should not have difficulty finding  is and this will give them some     process.
        a suitable donor. Conversely, if    assessment of how long the             When testing donor and
        the recipient has a  PGEN of        likely wait will be to receive a    recipient compatibility, one of the
        100%, they will have great          transplant.  There     are    no    main problems that has to be
                                                                                avoided is giving a patient a
          Caitriona and Susan,
          senior scientists reviewing                                           kidney to which they have
          antibody screening results                                            formed antibodies,  as this
          before performing a final                                             carries a high risk for the early
          crossmatch report
                                                                                failure of the transplant.
                                                                                   The process of checking the
                                                                                suitability of a donor is a long,
                                                                                but  in-depth one. To be as
                                                                                certain as possible that the
                                                                                transplant will be successful,
                                                                                for both recipient and donor,
                                                                                this  extensive procedure is
                                                                                necessary  and also gives the
                                                                                potential donor plenty of time to
                                                                                consider his/her options.

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