OPTIONS AND OUTCOMES IN THE SENSITIZED KIDNEY RECIPIENT

A. Bingaman¹, F. Wright², M. Kapturczak², C. Murphey^3
1Transplant Surgery, Methodist Specialty and Transplant Hospital, San Antonio/TX/UNITED STATES OF AMERICA, ², Methodist Specialty and Transplant Hospital, San Antonio/UNITED STATES OF AMERICA, ³, Southwest Immunodiagnostics, San Antonio/UNITED STATES OF AMERICA

Body: Introduction: Over the past 5 years the number of live donor kidney transplants in the United States has decreased by more than 20% while the waiting list has increased by almost 30,000 candidates. Many potential kidney transplant recipients are unable to receive a live donor transplant due to crossmatch or blood type incompatibility. Kidney paired donation (KPD) has been significantly underutilized as a modality to increase live donor transplantation. We established a single center database of blood type and crossmatch incompatible donor/recipient pairs in 12/07 and here we report the results of our KPD program. Methods: All recipients with consented incompatible donors were entered into our KPD database. In addition, consented non-HLA identical compatible pairs with older donors were entered into the database. HLA antibody detection was performed by single antigen bead technology using the Luminex platform. The KPD database identified potential donor/recipient pairs for transplant and flow cytometric crossmatching was performed to confirm immunologic compatibility. Non-directed donors were not used in this study. Results: The KPD database contains 192 recipients and 290 donors. Of the incompatible recipients, 60% are crossmatch incompatible and 40% are blood type incompatible with their donors. A total of 63 paired donor transplants have been done including 18 double exchange transplants and 9 triple exchange transplants. Over the past 12 months, our center has performed 162 live donor kidney transplants, of which 51 were KPD transplants, accounting for 31% of our live donor volume. The majority (37/63) of KPD recipients were sensitized, of which 29/37 (78%) had calculated panel reactive antibody (cPRA) > 40% including 15/37 (35%) highly sensitized recipients with cPRA > 80%. Disadvantaged groups with regard to levels of sensitization such as African Americans, females, and previous transplant recipients were all transplanted at a statistically significantly higher rate as a result of KPD compared with our compatible live donor program. All recipients of KPD transplants had negative T and B flow cytometric crossmatches at the time of transplant and 2/63 required desensitization for low level incompatibility. There have been no episodes of cellular or antibody mediated rejection and the median serum creatinine of recipients is 1.4mg/dl with a median follow up of 6 months. Conclusion: In less than 2 years, we have established amongst the largest KPD programs in the United States at a single center. KPD can dramatically increase the volume of live donor transplantation and should be practiced by all transplant centers. Broader national utilization of KPD could result in an additional 1,500 live donor kidney transplants per year in the United States and increase transplant rates of disadvantaged populations.

Disclosure: All authors have declared no conflicts of interest.