OPTIONS AND OUTCOMES IN THE SENSITIZED KIDNEY RECIPIENT

M. Rees¹, J. Kopke², R. Pelletier³, L. Chan⁴, L. Melton⁵, J. Rogers⁶, O. Pankewycz⁷, T. Taber⁸, B. Nibhanupudy⁹, C. Young¹⁰, A.B. Leichtman¹¹, C. Smith¹², S. Rees¹², L. Reece^12
1Urology, UNIV TOLEDO MED CENTER, TOLEDO/OH/UNITED STATES OF AMERICA, ², Collaborative Info Systems, Cincinnati/UNITED STATES OF AMERICA, ³, The Ohio State Univ, Columbus/UNITED STATES OF AMERICA, ⁴, University of Colorado, Denver/UNITED STATES OF AMERICA, ⁵, Baylor Univ., Dallas/UNITED STATES OF AMERICA, ⁶General Surgery, Wake Forest University School of Medicine, Winston-Salem/UNITED STATES OF AMERICA, ⁷Surgery, SUNY at Buffalo, BUFFALO/UNITED STATES OF AMERICA, ⁸, Undiana Univ Clarian Transplant Center, Indianapolis/UNITED STATES OF AMERICA, ⁹, Florida Hospital Transplant Center, Orlando/UNITED STATES OF AMERICA, ¹⁰, Univ of Alabama Hospital, Birmingham/UNITED STATES OF AMERICA, ¹¹Dept. Of Medicine, University of Michigan, Ann Arbor/MI/UNITED STATES OF AMERICA, ¹², Alliance for Paired Donation, Maumee/UNITED STATES OF AMERICA

Body: INTRODUCTION: Eighty transplant programs in 30 states have partnered to increase the access of their patients to a large pool of incompatible pairs for kidney paired donation (KPD). METHODS: Characteristics of kidney transplant candidates and their willing-but-incompatible donors were entered into a web-based matching program. Characteristics include: ABO, gender, ethnicity, HLA specificities, unacceptable antigens, height, weight, PRA, etiology of ESRD, and relationship of the donor (if any). Since February 2007, a computer match run has been performed every 4-6 weeks, generating a solution that simultaneously optimizes for quality and quantity of transplants in 2-, 3-, and 4-way matches as well as chains initiated by altruistic donors. Potential transplants were assigned a point score that weighted PRA, HLA match (DR > B > A), waiting time, pediatric status, travel distance, and relative ages of proposed donor and recipient. Computer optimization found the best solution that optimized total score and total number of transplants. RESULTS: Overall, 47 transplants have been performed. Recipient PRA was: PRA 0-19, 15 (32%); 20-49, 9 (19%); 50-79, 11 (23%); 80-100, 12 (26%). KPD pool candidate PRA was: PRA 0-19, 41%; 20-49, 10%; 50-79, 11%; 80-100, 38%. Recipient Race was: White, 37 (79%); Hispanic, 4 (9%); Black, 5 (11%), Indian, 1 (2%). Recipient Blood Type was: O, 23 (49%); A, 15 (32%); B, 8 (17%); AB 1, (2%). KPD pool candidate Blood Type was: O, 61%; A, 24%; B, 13%; AB, 2%. There were 21 (45%) male recipients and 26 (55%) female recipients. Overall average waiting time for recipients was 234 days from registration in the KPD system until day of transplant.CONCLUSIONS: Highly sensitized candidates and blood type O candidates can be transplanted at rates approaching their relativeproportion in the KPD pool when transplant centers work together. Increasing the pool size and designing a scoring system that favors highly sensitized patients while simultaneously maximizing thenumber of transplants improves chances for these hard to match patients.

Disclosure: All authors have declared no conflicts of interest.