Date: Sunday, June 3, 2018
Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Aim: It was recently estimated that 19.2% of imported kidneys go into an unintended recipient(UR), most commonly due to a positive crossmatch(AJT 2017, 17:2139) so we wanted to minimize this by using virtual cross match(VXM), even in highly sensitized patients(pts).
Methods: We developed a strategy to avoid a positive physical crossmatch(PXM), without limiting potential offers for broadly sensitized pts. We block only the core antibodies for these broadly sensitized pts. When a kidney is offered a VXM is performed, and likelihood of positive PXM is estimated by the HLA lab director. If there is significant concern due to recent transfusions, then a PXM is considered, but is only required in a minority of cases. Records were reviewed of all kidneys imported to our center since the kidney allocation changes took place in Dec, 2014 to identify kidneys shipped to our center, but not used in the intended recipient.
Results: 434 patients underwent deceased donor transplant between Dec, 2014 and Sept, 2017. A total of 252 kidneys were imported based on negative VXM, 210(83.3%) transplanted without a pre-tx PXM, and the remaining 42(16.7%) required a PXM on admission, most commonly necessitated by a recent blood transfusion. 109 pts with 100% cPRA had kidneys imported, and 93 (85.3%) were transplanted after VXM alone.
Creatinine at 1 year was 1.30 for pts at highest immunologic risk(cPRA 100%), and 1.31(p=NS) for all other DDRT recipients. VXM alone was used in 114(86.3%) of females, and 92(79%) of re-transplant pts. Consistent with the neg VXM, retrospective PXM for all recipients were negative.
7 imported kidneys went to UR, but only 3 (1.2%) were due to an unexpected pos PXM or new DSA from recent blood transfusion. The other 4 kidneys went to UR because the intended recipient had a new medical problem upon admission.
|cPRA||PXM IMPORTS (n=42)||VXM IMPORTS (n=210)|
|0-97%||20 (17.7%)||93 (82.3%)|
|98%||0 (0%)||1 (100%)|
|99%||6 (20.7%)||23 (79.3%)|
|100%||16 (14.7%)||93 (85.3%)|
Conclusions: Seamless sharing is possible, and late reallocations can be almost entirely avoided with a strategy that relies heavily on VXM, without limiting access to highly sensitized patients and females on the waitlist. More frequent antibody screening, especially following blood transfusions would further reduce the need for PXM.
CITATION INFORMATION: Roll G., Webber A., Travakol M., Gae D., Mayen L., Corpuz V., Roberts J., Ascher N., Stock P., Rajalingam R. Sharing Works; Avoiding Kidney Transplantation to an Unintended Recipient by Precision Virtual Cross Match with Excellent Outcomes Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Roll G, Webber A, Travakol M, Gae D, Mayen L, Corpuz V, Roberts J, Ascher N, Stock P, Rajalingam R. Sharing Works; Avoiding Kidney Transplantation to an Unintended Recipient by Precision Virtual Cross Match with Excellent Outcomes [abstract]. https://atcmeetingabstracts.com/abstract/sharing-works-avoiding-kidney-transplantation-to-an-unintended-recipient-by-precision-virtual-cross-match-with-excellent-outcomes/. Accessed July 22, 2019.
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