Background: Kidney paired donation (KPD) has become the standard of care for incompatible living donor pairs. Several mature national KPD programs exist yet KPD transplants only represent about 11% of total live donor transplants in the U.S., less than predicted by computer modeling. Methods: We initiated a single center KPD program in 2008. Consenting pairs were entered into our KPD database with blood types, HLA types and unacceptable antigens individually assigned based upon single antigen bead analysis. Results: Between March 2008 and October 2017 our single center KPD program has done 400 KPD transplants, representing 26% of total living donor transplants at our center. These transplants include 57 2-way exchanges, 36 3-way exchanges, 9 4-way exchanges, 6 5-way exchanges, 2 6-way exchanges and 13 non-directed donor (NDD) initiated chains ranging in length from 3-23 recipients. 218 patients were sensitized HLA incompatible with their original donors including 111 (51%) with cPRA >80% and 53 (24%) with cPRA >99%. 62 recipients (15.5%) were re-transplant patients. A total of 43 patients underwent desensitization for positive flow crossmatch or ABO incompatibility. A total of 222 (55%) blood type O donors were utilized of which 212 (95.5%) were transplanted into blood type O recipients or non-O recipients with cPRA >80%. 22 blood type A2 donors were utilized, of which 15 (68%) were transplanted into non-A recipients. 51 compatible pair donors were utilized of which 48 donors (94%) were blood type O or A2, and 3 donors (6%) were blood type A1. Compatible pairs participated in a total of 155 KPD transplants. All compatible pair recipients received kidneys from younger donors. Overall one year graft survival is 98.7%. Conclusions: We report the largest single center KPD program in the world. With limited NDDs, KPD programs must utilize blood type A2 donors and compatible pairs in order to transplant blood type O recipients effectively. To transplant the most highly sensitized patients, combination of KPD and desensitization is very effective with excellent outcomes.

CITATION INFORMATION: Bingaman A., Kapturczak M., Ashlagi I., Murphey C. 400 Kidney Paired Donor Transplants at a Single Center; The Methodist San Antonio Experience Am J Transplant. 2017;17 (suppl 3).

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