Purpose: Creating an effective living kidney donor process can be a challenge for transplant centers. There needs to be a balance between efficiency, resources, patient satisfaction and safety. In order to achieve these objectives, our transplant center identified a potential source of lost efficiency and revenue in obtaining Human Leukocyte Antibody (HLA) testing on all potential donors regardless of the recipients' panel reactive antibody (PRA) status. We hypothesized that by being more selective in when HLA testing is done we would improve efficiency and decrease the costs of testing.

Methods: A retrospective chart review was done looking at all potential kidney donors that contacted the transplant office in the calendar year 2015. The respective recipients of those donors had their PRA reviewed. An analysis was done to see how many donors had HLA drawn and went on to full kidney donor evaluation and transplant.

Results: 317 donors contacted the office interested in being a potential living kidney donor for 135 named recipients. 23 donors called with the aim of being an altruistic donor. Of those recipients, 71.9% (n=97) had a zero PRA. 77.3% of their donors (n=75) had HLA completed prior to evaluation, with 13.4% (n=13) having more than one donor obtain HLA testing. 50% (n=48) of these donors went on to have a full kidney transplant evaluation with 43.8% (n=21) moving on to donation.

27 donors had HLA completed for recipients with a zero PRA who never moved forward to evaluation. At approximately $3,000 per HLA sample, this is a total estimate cost of $81,000. Our center's experience has demonstrated that completion of donor HLA testing takes approximately 10-14 business days. 27 donors with an average of 12 days processing time, this could save 324 business days of reduced waiting time.

Conclusion: Kidney transplant centers are continuously looking for ways of improving efficiency and financial savings. One area of improvement is to focus on which donors obtain HLA and when, depending on their intended recipients PRA. By waiting until the evaluation to obtain HLA on donors for recipients with a zero PRA, donors may more efficiently move through the evaluation process by not having to wait for HLA results. In addition, kidney transplant centers may be able to prevent lost revenue in unnecessary HLA testing.

CITATION INFORMATION: Venniro E, Taylor J. Timing of HLA Testing as a Means of Reducing Cost and Increasing Efficiency of Living Kidney Donation. Am J Transplant. 2017;17 (suppl 3).

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