Session Name: Concurrent Session: Kidney Paired Exchange
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 206
*Purpose: Matching rates of very highly sensitized patients with cPRA of 91 – 100% (VHSP) and blood type O recipients of ABO incompatible donors (ABO I → O) remain relatively low in all reported single center and national KPD registries. We report our experience in matching and transplanting such difficult to match KPD recipients.
*Methods: The key features of our single center KPD program include: 1. Inclusion of HLA and ABO compatible pairs (CP) with poor HLA match. 2. As one of the matching goals, a qualified ABO Incompatible (ABO I) matching and/or low risk desensitization in the context of KPD for HLA incompatible (HLA I) VHSP. 3. As one of the matching goals, a downgrade of high risk ABO I in ABO I → O to low risk ABO I (A2 → O or B → O with low iso-agglutinin titer). 4. Emphasis on HLA class II matching for all KPD candidates. 5. High frequency match run utilizing Biologic Tx Matchgrid™ software.
*Results: After implementing the program in May 2016, and as of May 2018, our KPD pool consisted of 193 pairs; 124 (64%) were HLA I; 34 (17%) were ABO I; and 35 (19%) were CP. Match rates are presented in the following table:
|HLA I (N=124)||80/124||(64%)|
|VHSP: cPRA 91-94 (N=8)||7/8||(87%)|
|cPRA 95-97 (N=12)||9/12||(75%)|
|cPRA 98-100 (N=66)||31/66||(47%)|
|ABO I (N=34)||26/34||(76%)|
|ABO I → O (N=21)||13/21||(62%)|
Out of those matched, 100 patients (57 HLA I, 15 ABO I and 28 CP) were transplanted over the two-year period. The modalities of KPD were traditional 2-5 way paired exchange in 93 patients and one closed chain in seven patients. 28/57 (49%) of the transplanted HLA I were VHSP and 10/15 (66%) of transplanted ABO I were ABO I → O. Over an average follow-up period of 300 days, patient survival was 100%; graft survival was 99%; incidence of AMR was 0%; and incidence of ACR was 13% (Banff IA-IIB). Average serum creatinine was 90 umol/l (range: 55-169).
*Conclusions: Our single center KPD transplant volume and matching rates of difficult to match KPD candidates compare favorably to the best of those reported by other high volume single center and national KPD programs. Furthermore, their short term transplants outcome data compares favorably to those reported for high risk LD kidney transplantation.
To cite this abstract in AMA style:AlMeshari KA, Broering D, Alahmadi I, Raza S, Ali T, Alzayer F, Algharabli A. Transplant Nephrologist [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-nephrologist/. Accessed June 29, 2022.
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