The Art & Science of a Perfect Match

Our progress in kidney transplantation is driven by advanced immunology expertise of physicians, the clinical precision of surgeons, and the incredible generosity of donors. Together, this pairing of science and human kindness is changing lives, creating matches once thought impossible.

Traditionally, biologically incompatible donor–recipient pairs faced limited options, but national paired exchange networks and innovative tools to help recipients identify individuals willing to consider kidney donation like Giftworks, now enable swaps and donation chains that maximize access.

With the increase of possible donors using the paired exchange network, our team is advancing progress through the use of high-resolution histocompatibility matching, using Eplet mismatch analysis to evaluate compatibility at the molecular level. This precise matching allows many patients to undergo steroid-free regimens within a week, reducing long-term risks such as infection and cancer.

Each year, roughly 66% of our living donor kidney transplants are now leveraging these advanced living donor identification and paired exchange strategies. Even biologically compatible pairs are now entering these programs to secure an optimal match. “Our paired exchange program allows us to achieve the best possible immunologic match, improving long-term outcomes and reducing the need for immunosuppression,” said Michael Zimmerman, MD, Interim Chief of the Division of Transplantation.

Patients like Justin Zanik, General Manager of the Utah Jazz, illustrate this process: While Zanik had a known, non-compatible donor on his behalf, he was able to receive a kidney from an anonymous donor due to the national exchange and precise molecular matching.

Both directed and non-directed donors contribute to these chains, reflecting the incredible generosity that fuels transplantation.

“We are continually pushing science forward,” said Miklos Z. Molnar, MD, PhD. “Our next step is implementing PIRCHE algorithms.” This technology will detect indirectly recognizable HLA epitopes and further reduce immune burden, extending graft survival.

By advancing immunology and matching technology, we are expanding access and reshaping the future of kidney transplantation, one precisely matched kidney at a time.

(published in the FY25 Department of Surgery Annual report)