Single-Center Kidney Paired Donation: The Methodist San Antonio Experience

Abstract

Many potential kidney transplant recipients are unable to receive a live donor transplant due to crossmatch or blood type incompatibility. Kidney paired donation increases access to live donor transplantation but has been significantly underutilized. We established a kidney paired donation program including consented incompatible donor/recipient pairs as well as compatible pairs with older non-human leukocyte antigen identical donors. Over a 3-year period, a total of 134 paired donor transplants were performed, including 117 incompatible pairs and 17 compatible pairs. All transplants were done with negative flow cytometry crossmatches and five were done with desensitization combined with paired donation. Kidney paired donation transplants included two-way and three-way exchanges as well as three chains initiated by nondirected donors. Of the sensitized recipients transplanted by paired donation, 44% had calculated panel reactive antibody levels greater than 80%. Transplantation of females and prior transplant recipients was significantly higher with paired donation. Only three episodes of rejection occurred and no transplants were lost due to rejection. These data highlight the potential of kidney paired donation and suggest that all transplant centers should be actively engaged in paired donation to increase access to live donor transplantation.

The Canadian Kidney Paired Donation Program

“…This includes transplantation in the presence of donor specific antibody (i.e., when the flow cross-match is negative) or ABO incompatible transplants in HLA-matched recipients. 15 Consensus on the level of acceptable risk as well as a standardized approach to immunosuppression and clinical monitoring is needed before including low-risk DSA-positive transplants in the program.…”

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

“…The usefulness of KPD has been demonstrated by large single-center KPD programs that have used this approach for up to 35% of their living donor transplants (2)(3)(4). Theoretically, multi-center KPD programs with larger pools of donors and recipients should result in more transplants than single-center programs (5)(6)(7).…”

State of the Art Practices and Policies in Kidney Paired Donation

“…The median time from listing in the KPD database to transplantation was 4.5 months (range, 1-18). Of the transplanted patients, 63 % had crossmatch incompatibility with their original donors while 37 % had blood-type incompatibility [36].…”