Kidney allocation system changes have improved deceased donor kidney transplant (DDKT) access for highly sensitized patients. For patients with a willing live donor but requiring desensitization that receive a DDKT offer, it is unknown if the patient is best served accepting the immediate DDKT offer or pursuing incompatible live donor kidney transplantation (ILDKT).

Using a 22-center ILDKT cohort, we compared graft survival to DDKT matched controls stratified by ILDKT antibody strength and DDKT Kidney Donor Profile Index (KDPI). ILDKTs were matched 1:3 on PRA, age, blood group, previous kidney transplants, race, gender, diabetes, percent of renal replacement therapy with a functioning transplant, and transplant date.Graft outcomes were not different for ILDKT with positive Luminex and negative flow antibody strength and DDKT KDPI<86, though ILDKTs had a survival benefit versus DDKT KDPI 86-100. ILDKT with positive flow and negative cytotoxic crossmatch antibody strength was associated with worse graft survival than DDKT KDPI<35, equivalent outcomes to KDPI 35-85, and improved outcomes compared to KDPI 86-100. There was a trend towards worse graft survival for ILDKT with a positive cytotoxic crossmatch than DDKT KDPI<21, significantly worse survival compared to DDKT KDPI 21-85, and significantly better survival versus DDKT KDPI 86-100.

For highly sensitized patients choosing between ILDKT and DDKT, they should eschew offers for DDKT with KDPI 86-100, regardless of antibody strength. Whether or not to accept DDKT of other KDPI values, depends on the ILDKT antibody strength.

CITATION INFORMATION: Orandi B, Luo X, Garonzik-Wang J, Montgomery R, Segev D. Desensitization versus Deceased Donor Kidney Transplantation: What to Choose When Both Become Available? Am J Transplant. 2017;17 (suppl 3).

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