Global Kidney Exchange

D. N. Bozek¹, O. Ekwenna¹, S. Paloyo², T. Dunn³, K. Krawiec⁴, S. Rees⁵, A. Roth⁶, M. Zimmerman⁷, J. Punch⁸, R. Forbes⁹, C. Marsh¹⁰, C. Kuhr¹¹, J. Rogers¹², M. Tan¹³, L. Basagoitia¹⁴, R. Correa-Rotter¹⁵, J. Ortiz¹, P. Sindhwani¹, M. A. Rees¹

¹University of Toledo Medical Center, Toledo, OH, ²University of the Philippines – Philippine General Hospital
St. Luke’s Medical Center, Manila, Philippines, ³University of Minnesota, Minneapolis, MN, ⁴Duke University, Durham, NC, ⁵Alliance for Paired Donation, Perrysburg, OH, ⁶Stanford University, Stanford, CA, ⁷Froedert Hospital-Medical College of Wisconsin, Milwaukee, WI, ⁸University of Michigan, Ann Arbor, MI, ⁹Vanderbilt University Medical Center, Nashville, TN, ¹⁰Scripps Green Hospital, San Diego, CA, ¹¹Virginia Mason Medical Center, Seattle, WA, ¹²Wake Forest Baptist Medical Center, Winston-Salem, NC, ¹³Piedmont Hospital, Atlanta, GA, ¹⁴ProRenal, ., Mexico, ¹⁵INNSZ, Mexico City, Mexico

Meeting: 2019 American Transplant Congress

Abstract number: 509

Keywords: Allocation, Economics, Ethics, Kidney transplantation

Session Information

Session Name: Concurrent Session: Kidney Paired Exchange

Session Type: Concurrent Session

Date: Tuesday, June 4, 2019

Session Time: 2:30pm-4:00pm

Presentation Time: 2:42pm-2:54pm

Location: Room 206

*Purpose: Poverty prevents more kidney transplants (KTs) worldwide than any other barrier. Global kidney Exchange (GKE) is a mechanism to overcome this barrier.

*Methods: In high-income countries (HIC), KTs generate significant savings compared with paying for ongoing dialysis. GKE proposes paying for KTs (and donor and recipient follow-up care) for some low/middle income country (LMIC) patients that face financial barriers to transplantation. In so doing, LMIC patients receive life-saving treatment, additional KTs are produced for HIC patients, and the savings from avoided dialysis exceeds the cost.

*Results: Between January of 2015 and June of 2018, GKE has produced 5 chains and 2 cycles that has allowed 7 international patients (3 from The Philippines, 3 from Mexico, and 1 from Denmark) to be transplanted, as well as 29 KTs for patients in the United States (US). The lengths of each GKE chain are 12, 7, 6, 2, 4 and the cycle lengths were 3 and 2. GKE-1 began with a US non-directed donor giving to a Filipino recipient and ended with a donation to the deceased donor wait list. GKE-2 extended a chain with a blood type (BT)-A bridge donor (BD) to produce 3 transplants and a BT-A BD. This BD began GKE-5 to produce 4 additional KTs. GKE-3, -4, and -5 each have a BD pending; GKE-6 and -7 were completed as cycles. GKE chains have involved 17 transplant centers and 38.9% of recipients were minorities. Five US recipients had BT-A, 20 BT-0, 3 BT-B, and 1 BT-AB; 5 international recipients had BT-A and 2 had BT-O. The PRA was 0-20% for 13 patients, 21-79% for 13 and > 80% for 10 (4 international). International pairs were funded by a combination of self-pay and approximately $500K of philanthropy. Transplanting 29 US patients saved US healthcare payers $5-7M vs. dialysis. International recipients have 100% graft survival (longest 3.75 years) and all international donors have normal creatinine and blood pressure.

*Conclusions: GKE provides a mechanism to overcome financial and immunological barriers to transplantation. Savings from avoided dialysis offers scalability, but transparency of international pair selection, emphasis on donor safety, and assurance of longterm immunosuppression for recipients are prerequisites for sustainability.

To cite this abstract in AMA style:

Bozek DN, Ekwenna O, Paloyo S, Dunn T, Krawiec K, Rees S, Roth A, Zimmerman M, Punch J, Forbes R, Marsh C, Kuhr C, Rogers J, Tan M, Basagoitia L, Correa-Rotter R, Ortiz J, Sindhwani P, Rees MA. Global Kidney Exchange [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/global-kidney-exchange-3/. Accessed November 22, 2024.

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