In kidney paired exchange (KPE) programs, the use of incompatible transplantation has been necessary to prevent long waiting times for sensitized candidates and to facilitate a maximal number of matches. The prevalence and characteristics of candidates who undergo desensitization as part of KPE is unclear.

Methods: We studied National Kidney Registry (NKR)-matched kidney transplant recipients 2011-2017 to describe the practice of desensitization in a large national KPE clearinghouse in the US.

Results: Out of 2098 NKR-matched recipients, 177 (8.4%) underwent desensitization prior to transplant. These transplants occurred at 35 (41.2%) transplant centers out of the 85 that had at least one NKR-matched recipient during the study period. Desensitized recipients, in comparison to compatible recipients, had similar age and sex but were less likely African American (8.6% vs. 18.4%, p=0.005, Table 1). Desensitized recipients had a median PRA of 91% compared to 13% for compatible recipients (p<0.001), and were more likely to have had a previous kidney transplant (52.5% vs. 20.5%, p<0.001, Table 1). Desensitized recipients experienced a longer wait to NKR match (median 3 months vs. 2 months, p<0.001). The most frequent desensitization protocols reported included IVIg only (24.3%), IVIg with plasmapheresis (18.1%), and plasmapheresis only (9.6%, Table 2).

Conclusion: Improved understanding of national practices in incompatible transplantation as part of KPE can help facilitate transplantation for sensitized candidates.

CITATION INFORMATION: Holscher C., Thomas A., Jackson K., Haugen C., Ronin M., Waterman A., Massie A., Garonzik Wang J., Segev D. Desensitization to Facilitate Matching in a Large, National Kidney Paired Exchange Clearinghouse Am J Transplant. 2017;17 (suppl 3).

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