OPO Strategies to Prevent Unintended Use of Kidneys Exported for High PRA (>98% cPRA) Recipients.
Since the advent of the Kidney Allocation System (KAS), matched candidates with high (>98%) panel reactive antibody (hPRA) are given priority over local candidates with lower PRA. This often leads to exporting of kidneys. Data for these kidneys are not detailed on routine reports. Twenty-two organ procurement organizations prospectively submitted data from August 2015 to July 2016, describing allocation practices of kidneys to hPRA patients and outcomes of these kidneys. Five hundred twenty out of 6924 procured kidneys were exported for hPRA recipients. Of these, 402 (77.3%) were transplanted into the intended recipient (IR); 100 (19.2%) were transplanted into unintended recipients (UR), and 18 (3.5%) were discarded. The most common reason for use in an UR was a positive crossmatch (XM) (63%). The most common reasons for discard were donor quality (44%) and ischemic time (39%). Prior to kidney export, when tissue crossmatching was done, 96.2% of the kidneys went to the IR, versus 80.7% following virtual CM, versus 56.7% when no crossmatching was performed (p < 0.0001). A significant number of kidneys exported for hPRA patients are not being used in the IR or are being discarded. The most common reason for this is positive tissue XM. We report that unintended use of the kidney was minimized when tissue was shipped and XM results were known prior to exporting the kidney.
Department of Surgery, Tulane University School of Medicine, New Orleans, LA.|Louisiana Organ Procurement Agency, Metairie, LA.
A S
AS
Paramesh
Donor Network West, San Ramon, CA.
N
N
Neidlinger
Donor Network West, San Ramon, CA.
M
M
Salvatore
Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
A
A
Smith
LiveOnNY, New York, NY.
A
A
Friedman
Department of Surgery, University of Minnesota, Minneapolis, MN.
W
W
Payne
Section of Nephrology, Indiana University School of Medicine, Indianapolis, IN.
T
T
Taber
Lifelink of Florida, Tampa, FL.
C
C
Wright
D046148:Donor Selection; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D011379:Prognosis; D011446:Prospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*
D006680:HLA Antigens; D007518:Isoantibodies
alloantibody; clinical research/practice; crossmatch; health services and outcomes research; histocompatibility; kidney transplantation/nephrology; organ allocation; organ procurement and allocation; organ procurement organization; panel reactive antibody (PRA)