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Acceptable Mismatch Program (AM)

The AM program is conducted by the ETRL. The AM program is open for every highly sensitized patient awaiting a kidney transplantof any of the countries participating in ET. Current or historical sensitization against HLA-A, B, C (Class I) and HLA-DR, DQ (Class II) is regarded equally important. The TTC must control first whether their patients have anti Class I and/or II antibodies using solid phase assays prior to apply for inclusion in the AM program. To be included, patients awaiting a kidney (re) transplant have to meet the following criteria:


Definition of AM

AM can be defined by:


Submission of the data:

Procedure AM program

Repeated HLA mismatches for broad and split HLA-A,B,DR antigens are considered a contra indication for transplantation, unless otherwise reported

Selection of potential organ donors

The HLA-A,B,(C), and DR,(DQ) typing of an organ donor is entered in ENIS. Potential recipients will be selected on the basis of their own HLA-A,B,C and DR,DQ antigens in combination with the AM. The AM are regarded as the patient's own HLA antigens. Full compatibility between donor and patients including the AM is a prerequisite for allocation of kidneys via the AM program.

The ETRL immunologist on duty is informed about every potential offer. After acceptance, the respective TC is informed, and if accepted, the kidney must immediately be dispatched. The crossmatch must be performed in the recipient TTC using both current and historical sera if available. In case of a negative crossmatch the transplantation can be performed. Repeated HLA mismatches for broad and split HLA-A,B,DR antigens are regarded as a contraindication for transplantation, unless otherwise reported.

NB Antibodies against HLA-C and HLA-DQ are reported as unacceptable antigens but are taken into consideration only when the organ donor is typed for these specificities.

For patients with a chance >0.1% of receiving an organ, minimal match criteria of one HLA-B and one HLA-DR sharing or 0 MM HLA-DR apply.

The order by which the kidneys will be offered in case of multiple recipients is according to the calculated chance to receive an organ as provided by the ETRL (Donor Frequency Calculator). Patients with the lowest chance get the highest priority.

AM forms

Laboratory Form 

Application form AM