Assessing the efficacy of kidney paired donation--performance of an integrated three-site program.
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.
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.
Han
H
Li
Mark D
MD
Stegall
Patrick G
PG
Dean
Edward T
ET
Casey
Kunam S
KS
Reddy
Hasan A
HA
Khamash
Raymond L
RL
Heilman
Martin L
ML
Mai
C Burcin
CB
Taner
Catherine L
CL
Kosberg
Lisa L
LL
Bakken
Elmira J
EJ
Wozniak
Kathleen L
KL
Giles
Lisa A
LA
Veal
Manish J
MJ
Gandhi
Fernando G
FG
Cosio
Mikel
M
Prieto
D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014850:Waiting Lists
D000017:ABO Blood-Group System; D007518:Isoantibodies