Chronic kidney disease (CKD) is a major global health issue and a leading cause of death. For many patients, kidney transplantation is the best available treatment, offering longer life and better health. However, transplants are complex, expensive and risky; many fail due to the body’s immune system rejecting the new kidney. This rejection is often triggered by differences in proteins called human leukocyte antigens (HLA), which vary widely between people.  HLAs are proteins on the surface of most cells that help the immune system distinguish the body's own cells from foreign cells that may be a risk. 

With over 36,000 known variations of HLA proteins, perfect matches are rare—especially in large, sparsely populated countries like Canada. Previous research by this team showed that instead of matching entire HLA proteins, focusing on smaller parts called “eplets” (tiny regions where antibodies bind) can be more effective. Matching donors and recipients at the eplet level significantly reduces the risk of rejection and improves long-term transplant success.

This project, in partnership with Canadian Blood Services, aims to revolutionize kidney transplantation in Canada by introducing a national program that uses advanced gene sequencing to match donors and recipients at the eplet level. The team will first implement Oxford Nanopore sequencing technology in British Columbia, then expand it to all 12 regional HLA labs across Canada. Using this technology, they will launch a world-first organ allocation system based on molecular compatibility, ensuring better matches without increasing wait times. Finally, they will assess the program’s impact on patient outcomes, healthcare costs and overall system efficiency.

By improving how kidneys are matched to recipients, this initiative aims to reduce rejection rates, extend the life of patients with transplanted kidneys and ease the burden on patients and the healthcare system.