High Volume, Highly Efficient, Outcome- Centric KPD Program: A Single Center Experience with Direct Exchange Based Strategies
King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Meeting: 2020 American Transplant Congress
Abstract number: 31
Keywords: Alloantibodies, Graft survival, Kidney, Kidney transplantation
Session Information
Session Name: Kidney Paired Exchange
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:15pm-4:27pm
Location: Virtual
*Purpose: We report our three and a half year experience with direct exchange (loop) based strategy single center KPD program.
*Methods: 1. Inclusion of HLA and ABO compatible pairs (CP) with poor HLA match. 2. A qualified ABO Incompatible (ABO I) matching and/or low risk desensitization in the context of KPD for HLA incompatible (HLA I) with cPRA of more than 80%. 3. A downgrade of high risk ABO I in ABO I → O pairs to low risk ABO I (A2 → O or B → O with low iso-agglutinin titer) or ABO I neutral matching for ABO I pairs who demonstrate poor HLA matching and/or associated HLA I. 4. Emphasis on HLA class II matching for all KPD candidates. 5. High frequency match run utilizing Biologic Tx Matchgrid™ software.
*Results: Between May 2016 and November 2019, 153 KPD transplants were performed. The main KPD modality was conventional direct exchanges (2-5) in 95% of KPD transplants. The main contributor to our KPD pool was HLA I pairs (more than 67%). 96/153 (63%) KPD transplants were HLA I; 20/153 (13%) were ABO I and 37/153 (24%) were HLA C. 108/153 KPD transplants were conventional; 27/153 (18%) required desensitization in the context of KPD; and 18/153 (12%) required ABO I matching. 28/96 (29%) of HLA I KPD transplants had cPRA more than 98%; 8/96 (8%) of HLA I KPD transplants were both HLAI and ABO I; and 12/20 (60%) of ABO I transplants were in blood type O recipients. Patients survival was 98%, death censored graft survival was 99%; incidence of AMR was 0%; incidence of ACR (Banff IA – Banff IIB) was 20/153 (13%). 130/153 (85%) of KPD recipients received kidneys with ≥ 50% matching in HLA class II (DR and DQ). Average serum creatinine over the follow-up period was 90 umol/l (range 55 – 169).
*Conclusions: Despite the scarcity of NDD – triggered chains in our experience, our single center KPD program was successful in performing high volume KPD transplants. Furthermore, it was highly efficient in transplanting difficult to match HLA I and ABO I pair candidate. The short term outcome results compare favorably to those reported for high risk LD kidney transplants. Finally, the high degree of HLA class II matching portends favorable long term prognosis.
To cite this abstract in AMA style:
Meshari KAl, Broering D, Alahmadi I, Raza S, Ali T, Alabbassi A, Alahdal H, Alzayer F. High Volume, Highly Efficient, Outcome- Centric KPD Program: A Single Center Experience with Direct Exchange Based Strategies [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/high-volume-highly-efficient-outcome-centric-kpd-program-a-single-center-experience-with-direct-exchange-based-strategies/. Accessed May 16, 2025.« Back to 2020 American Transplant Congress