Compatible Pairs in Paired Kidney Exchange – Are There Winners and Loosers?
1UCSF, San Francisco, CA, 2Georgetown Univ, Washington, DC, 3UC Hospital, Cincinnati, OH, 4NKR, Babylon, NY, 5Cleavland Clinic, Cleavland, OH, 6Johns Hopkins, Baltimore, MD, 7Univ of Wisconsin, Madison, WI, 8UCLA and Terasaki Research Institute, Los Angeles, CA
Meeting: 2019 American Transplant Congress
Abstract number: 510
Keywords: Donors, unrelated, Highly-sensitized, Kidney transplantation
Session Information
Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Kidney Paired Exchange
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Room 206
*Purpose: To understand patterns of participation for compatible pairs and their impact in increasing paired donation in a national registry.
*Methods: Favorable pairs (FP) are defined as non-O recipients with O donors, or AB recipients with non-AB donors. Additional transplants were calculated, excluding end-chain recipients. A retrospective review of the National Kidney Registry (NKR) for CP entered between 2/14/2008 – 11/2/2018 and the number of additional tx made possible including blood groups and recipient level of sensitization was collected.
*Results: 151 CP were entered into the NKR with increasing frequency over the study period (fig 1). 73 (48.3%) of these CP were FP. 296 additional tx were facilitated following the addition of CP in multiple paired chains (1.96 additional tx per CP). These additional recipients were often highly sensitized (76 recipients with cPRA>80%, 32>95%, 4>98%, and 10≥99%). 35 recipients with a cPRA >80% (19 with cPRA>95%) were matched directly to the CP donor. Incompatible blood group O candidates received the greatest benefit with CP. 64 O recipients matched directly to a FP donor while their compatible recipient was transplanted with a comparable non-O donor.
*Conclusions: The initial goal of paired kidney exchange was to improve access to tx for incompatible pairs. As the pool of highly sensitized recipients grew (particularly blood group O) the transplant community recognized the value of CP in PKE. CP improves matching by infusing favorable O donors and transplanting highly sensitized patients. In this review, 296 additional recipients, notably blood group O and highly sensitized recipients, who demonstrate lengthy wait times received transplants from compatible donors. Each CP allowed for 2 additional transplants, 25% of whom had a cPRA >80%, and 11% with a cPRA>95%. Meanwhile recipients of CP were not disadvantaged receiving organs from comparable donors. While decisions for CP to participate in paired exchange are complex, these data are valuable to properly counsel patients.
To cite this abstract in AMA style:
Chipman V, Lee B, Cooper M, Cuffy MC, Ronin M, Hil G, Flechner S, Thomas A, Mandelbrot DA, Waterman AD, Freise CE, Roll GR. Compatible Pairs in Paired Kidney Exchange – Are There Winners and Loosers? [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/compatible-pairs-in-paired-kidney-exchange-are-there-winners-and-loosers/. Accessed March 4, 2021.« Back to 2019 American Transplant Congress