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Transplantation. 2019 Sep 4. doi: 10.1097/TP.0000000000002947. [Epub ahead of print]

Ten Years of Kidney Paired Donation at Mayo Clinic: The Benefits of Incorporating ABO/HLA Compatible Pairs.

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Emory Transplant Center and Division of Nephrology and Hypertension, Emory University School of Medicine, Atlanta, Georgia.
Mayo Clinic William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota.
Division of Transplantation, Mayo Clinic, Jacksonville, Florida.
Division of Transplantation, Mayo Clinic, Scottsdale, Arizona.



We examined the 10 year experience of Mayo Clinic's kidney paired donation (KPD).We aimed to determine the benefits for the recipients of enrolled ABO/HLA compatible pairs and determine the factors associated with prolonged KPD waiting time.


We performed a retrospective study of 332 kidney transplants facilitated by the Mayo 3-site KPD program from 9/2007- 6/2018.


The median (IQR) time from KPD entry to transplantation was 89(42-187) days. The factors independently associated with receiving a transplant > 3 months after KPD entry included recipient blood type O and cPRA (calculated panel reactive antibodies) ≥ 98%. Fifty-four ABO/HLA compatible pairs participated in KPD for the following reasons: CMV mismatch [18.5 %(10/54)], EBV mismatch (EBV) [9.3 %(5/54)], age/size mismatch [51.9 %(28/54)] or altruistic reasons [20.3 %(11/54)]. CMV and EBV mismatch was avoided in 90 %(9/10) and 100 %(5/5) of cases. Recipients who entered KPD for age/size mismatch and altruistic reasons received kidneys from donors with lower Living Kidney Donor Profile Index (LKDPI) scores than their actual donor [median (IQR) 31.5(12.3, 47) p<.001, and 26(-1, 46), p=0.01 points lower, respectively]. Median time to transplant from KPD entry for compatible pair recipients was 70(41-163) days, and 44.4 %(24/54) of these transplants were preemptive. All chains/swaps incorporating compatible pairs included ABO/HLA incompatible pairs.


KPD should be considered for all living donor/recipient pairs because the recipients of these pairs can derive personal benefit from KPD while increasing the donor pool for difficult to match pairs.

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