title: Incompatible live-donor kidney transplantation in the United States: results of a national survey.
abstract: OBJECTIVE
  Use of incompatible kidney transplantation (IKT) is growing as a response to the organ shortage and the increase in sensitization among candidates. However, recent regulatory mandates possibly threaten IKT, and the potential effect of these mandates cannot be estimated because dissemination of this modality remains unknown. The goal of this study was to better understand practice patterns of IKT in the United States.
  
  
  METHODS
  Directors from all 187 unique active adult kidney transplant programs were queried about transplantation across the following antibody barriers: positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); positive cytotoxic crossmatch (PCC); and ABO incompatible (ABOi).
  
  
  RESULTS
  Responses from 125 centers represented 84% of the live-donor transplant volume in the United States. Barriers of PLNF, PFNC, PCC, and ABOi are being crossed in 70%, 51%, 18%, and 24%, respectively, of transplant centers that responded. Desensitization was performed in 58% of PLNF, 76% of PFNC, 100% of PCC, and 80% of ABOi using plasmapheresis and low-dose intravenous Ig (IVIg) in 71% to 83% and high-dose IVIg in 29% to 46%.
  
  
  CONCLUSIONS
  A higher proportion of centers perform IKT than might be inferred from the literature. The rapid dissemination of these protocols despite adequate evidence of a clear advantage of IKT transplants argues for the creation of a national registry and randomized studies.
authors.affiliation: Transplant Surgery, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 771B, Baltimore, MD 21205, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Garonzik Wang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Kucirka
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Berger
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D001787:Blood Group Incompatibility / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D003888:Desensitization, Immunologic / Q000379:methods; D019317:Evidence-Based Medicine; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D019538:Health Care Surveys; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D019520:Living Donors / Q000600:supply & distribution*; D010956:Plasmapheresis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors