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Transplantation. 2014 Aug 15;98(3):300-5. doi: 10.1097/TP.0000000000000054.

Assessing the efficacy of kidney paired donation--performance of an integrated three-site program.

Author information

1
1 William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN. 2 Mayo Clinic Arizona Transplant Center, Mayo Clinic, Phoenix, AZ. 3 Department of Transplantation, Mayo Clinic, Jacksonville, FL. 4 Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN. 5 Address correspondence to: Mark D. Stegall, M.D., Division of Transplantation Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Abstract

BACKGROUND:

Kidney paired donation (KPD) has emerged as a viable option for renal transplant candidates with incompatible living donors. The aim of this study was to assess the "performance" of a three-site KPD program that allowed screening of multiple donors per recipient.

METHODS:

We reviewed retrospectively the activity of our KPD program involving three centers under the same institutional umbrella. The primary goal was to achieve a transplant that was both ABO compatible and had a negative or low-positive flow cytometric crossmatch (+XM).

RESULTS:

During the 40-month study period, 114 kidney transplant candidates were enrolled-57% resulting from a +XM and 39% resulting from ABO incompatible (ABOi) donors. Important outcomes were as follows: (1) 81 (71%) candidates received a transplant and 33 (29%) were still waiting; (2) 368 donors were evaluated, including 10 nondirected donors; (3) 82% (37/45) of ABOi candidates underwent transplantation; (4) 56% (36/65) of +XM candidates underwent transplantation (however, all but four of these had a cPRA less than 95%); (5) at the end of the study period, 97% (28/29) of +XM candidates still waiting had a cPRA greater than 95%.

CONCLUSIONS:

These data suggest evaluating large numbers of donors increases the chances of KPD. Patients with a cPRA greater than 95% are unlikely to receive a negative or low-positive +XM, suggesting the need for desensitization protocols in KPD.

PMID:
24699400
DOI:
10.1097/TP.0000000000000054
[Indexed for MEDLINE]

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