Inclusion of Compatible Pairs in the Australian Paired Kidney Exchange Program

E. van Hardeveld¹, S. McGinn², L. Cantwell³, M. Kummrow³, P. Hughes¹

¹Nephrology, Royal Melbourne Hospital, Melbourne,Victoria, Australia, ²Nephrology, Royal North Shore Hospital, Sydney, New South Wales, Australia, ³Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne,Victoria, Australia

Meeting: 2019 American Transplant Congress

Abstract number: B295

Keywords: Kidney transplantation

Session Information

Session Name: Poster Session B: Kidney Paired Exchange

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: The Australian paired kidney exchange (AKX) program allows the inclusion of compatible pairs (CP) to allow improved immunological matching. Previous modelling showed that inclusion of CP would allow improved matching for poorly matched pairs and increased rates of transplantation for incompatible pairs in the pool. We report the experience with CP during 2017-2018.

*Methods: Data on CP was extracted from the AKX database and the Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service. Eplet mismatches were calculated using HLA matchmaker v2.1.

*Results: Seventeen pairs were considered to be compatible out of 159 involved in match runs over this time. Characteristics of the recipients who were considered as compatible pairs are shown in figure 1. The reasons that recipients were entered into AKX are shown in table 1. The average age of recipients in CP was 41.5 years although those entered solely due to poor eplet matching were younger (31.9 years). Sixteen of the 17 recipients were transplanted in AKX, the remaining one was offered a match but declined it due to the presence of a very low level DSA and then proceeded with a direct live donor transplant. Of those who were transplanted in AKX, 14 received their offer in the first match run while 2 received it in the second. Of those who were transplanted in the AKX, those that began with poor matching with their original donor (groups 1,2,4) had better matching with the matched donor (Table 2). No improvement in elet matching was seen in the other groups. Two recipients accepted a kidney from a donor against whom they had low level DSAs. Two different recipients accepted a kidney from an ABO incompatible donor. Those transplanted in AKX were in 13 separate chains which included 42 incompatible pairs. Of these 15 had a cPRA>90% and 5 had a cPRA>97%.

*Conclusions: A range of pairs entered into paired exchange programs can be considered to be compatible. In the AKX the majority of those entered received an offer in the first match run. Those entered due to poor eplet matching typically received a kidney from a better matched donor. Compatible pairs might facilitate increased matching in a paired exchange program including in highly sensitised incompatible pairs.

Table 1. Reasons for entry into AKX.
Group	Reason for entry into AKX	Number of pairs	Average age of recipients
1	High level of eplet mismatch	7	31.9
2	High level of eplet mismatch with low level DSA	5	40.6
3	Repeat mismatch without detectable DSA	2	60
4	Male to female partner with previous pregnancy, low level DSA and high eplet mismatch	2	48
5	Altruism	1	64

Table 2. Number of eplet mismatches with original donor and matched donor.
		Mean total number of mismatched eplets with original donor	Mean total number of mismatched eplets with matched donor	Mean reduction in total eplet mismatch
1	High level of eplet mismatch	78.7	38.3	41.3
2	High level of eplet mismatch with low level DSA	78.8	56.2	22.6
3	Repeat mismatch without detectable DSA	28.5	62.5	-34
4	Male to female partner with previous pregnancy, low level DSA and high eplet mismatch	77.5	32.5	45
5	Altruism	50	50	0

To cite this abstract in AMA style:

Hardeveld Evan, McGinn S, Cantwell L, Kummrow M, Hughes P. Inclusion of Compatible Pairs in the Australian Paired Kidney Exchange Program [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/inclusion-of-compatible-pairs-in-the-australian-paired-kidney-exchange-program/. Accessed May 18, 2025.

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