Clinical Outcomes of Paired Kidney Exchange for Highly Sensitized Renal Transplant Recipients
Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC
Histocompatibility Laboratory, Georgetown University Hospital, Washington, DC
Meeting: 2013 American Transplant Congress
Abstract number: A830
Purpose: A local multicenter paired kidney exchange (PKE) was employed to facilitate identification of compatible donors for highly-sensitized recipients.
Methods: Virtual crossmatching was used to identify donors against whom the recipients had no donor specific antibody (0 DSA) or the donor with the least and lowest titer DSA. Recipients with DSA or ABO incompatibility were treated with a combination of plasmapheresis + Cytogam pre and post transplantation ± rituximab ± bortezomib.
Results: 51 patients underwent living-unrelated kidney transplantation from 2009 to 2011. The exchange included 75% minority recipients and 38% highly sensitized patients with cPRA ≥ 80%. Nine highly sensitized patients were transplanted with 0 DSA donors, 4 of these 9 were desensitized and transplanted with ABO incompatible donors. Eleven recipients were desensitized and transplanted with acceptable-level DSA donors, 5 of these 11 had class I antibody (MFI 1,300 – 10,000; titers 1:4 -1:64), 3 had class II DSA (MFI 1,200 – 8,500, titers 1:4 -1:32), and 3 had both class I and II antibody. At the time of transplant, of the 11 desensitized patients, 6 had negative and 5 had positive flowcytometric crossmatches (maximum MCS 195). The median serum creatinine at 6 months was 1.64mg/dL±1.28 (range of 0.8mg/dL-3.83mg/dL), at 1 year was 1.43mg/dL±1.08 (range of 0.7mg/dL-7.27mg/dL) and at 2 years was 1.70mg/dL±1.10 (range of 0.9mg/dL-6.39mg/dL). There were 2 patient deaths with a functioning graft and 3 graft loses. Two graft loses were due to non compliance. One of the patients who was desensitized died with a functioning graft. All the other patients that required desensitization have stable renal functions.
Conclusions: The 1 and 2 year patient and graft survival is comparable with the outcomes of standard non sensitized renal transplant. Our results demonstrate highly sensitized patients can benefit from PKE as it increases the likelihood of finding a 0 DSA donor or acceptable-level DSA donor with successful desensitization.
To cite this abstract in AMA style:
Grafals M, Cooper M, Verbesey J, Vucci J, Javaid B, Timofeeva O, Rosen-Bronson S. Clinical Outcomes of Paired Kidney Exchange for Highly Sensitized Renal Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/clinical-outcomes-of-paired-kidney-exchange-for-highly-sensitized-renal-transplant-recipients/. Accessed May 17, 2025.« Back to 2013 American Transplant Congress