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12-OR Kidney paired donation (KPD) in a single center – a paradigm shift
S10
12-OR
Abstracts
KIDNEY PAIRED DONATION (KPD) IN A SINGLE CENTER – A PARADIGM SHIFT. Anat R. Tambur, Nicole Beauvais, Emily Warren, Maria Hendricks, Joe Leventhal, John Friedewald. Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA. Aim: Desensitization became a routine pathway to transplant patients with living donors who are either HLA- or ABO-incompatible. Kidney paired donation allows to circumvent or at least minimize the immunological barrier for those pairs in whom desensitization is not feasible. We have initiated a single center KPD program and analyzed its effects on our current practices. Methods: The IKx software from JHMC was utilized in addition to other clinically relevant data in order to identify the best match for each recipient as well as to determine the most effective chains. Weekly meetings between the laboratory and the clinical staff were conducted for these analyzes. Results: In the 24 months prior to our KPD program, 50 pts (41 HLAi, 9 ABOi) required desensitization out of a total of 316 recipients of living kidney transplant. Six/50 received Rituximab only and the rest had the complete desensitization protocol including plasmapheresis, IVIg and Rituximab. Highest average starting DSA titer was 1:64. During the last year, when the KPD program began, 79 pairs were entered into the database and 43 pairs have been transplanted to date (54%). This translated to 25% of the living donor transplant volume at NMH during the last year. Of those 43 patients, 18 received desensitization therapy, however, 10/18 required the use of Rituximab only and the remaining 8 received the complete desensitization protocol. The highest average starting DSA titer was 1:8. As a result of non-directed donor chains (initiated by “good Samaritan” donors) seven patients on the deceased donor wait list were transplanted. Conclusions: Our single center experience confirms that KPD offers options for HLAi and ABOi patients. A significant level of collaboration is required between the laboratory and the clinical staff to maximize the potential options. KPD can reduce or eliminate the need for desensitization and shorten time to transplant.
12-OR
Abstracts
KIDNEY PAIRED DONATION (KPD) IN A SINGLE CENTER – A PARADIGM SHIFT. Anat R. Tambur, Nicole Beauvais, Emily Warren, Maria Hendricks, Joe Leventhal, John Friedewald. Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA. Aim: Desensitization became a routine pathway to transplant patients with living donors who are either HLA- or ABO-incompatible. Kidney paired donation allows to circumvent or at least minimize the immunological barrier for those pairs in whom desensitization is not feasible. We have initiated a single center KPD program and analyzed its effects on our current practices. Methods: The IKx software from JHMC was utilized in addition to other clinically relevant data in order to identify the best match for each recipient as well as to determine the most effective chains. Weekly meetings between the laboratory and the clinical staff were conducted for these analyzes. Results: In the 24 months prior to our KPD program, 50 pts (41 HLAi, 9 ABOi) required desensitization out of a total of 316 recipients of living kidney transplant. Six/50 received Rituximab only and the rest had the complete desensitization protocol including plasmapheresis, IVIg and Rituximab. Highest average starting DSA titer was 1:64. During the last year, when the KPD program began, 79 pairs were entered into the database and 43 pairs have been transplanted to date (54%). This translated to 25% of the living donor transplant volume at NMH during the last year. Of those 43 patients, 18 received desensitization therapy, however, 10/18 required the use of Rituximab only and the remaining 8 received the complete desensitization protocol. The highest average starting DSA titer was 1:8. As a result of non-directed donor chains (initiated by “good Samaritan” donors) seven patients on the deceased donor wait list were transplanted. Conclusions: Our single center experience confirms that KPD offers options for HLAi and ABOi patients. A significant level of collaboration is required between the laboratory and the clinical staff to maximize the potential options. KPD can reduce or eliminate the need for desensitization and shorten time to transplant.