title: Kidney paired exchange and desensitization: Strategies to transplant the difficult to match kidney patients with living donors.
abstract: With organs in short supply, only a limited number of kidney transplants can be performed a year. Live donor donation accounts for 1/3rd of all kidney transplants performed in the United States. Unfortunately, not every donor recipient pair is feasible because of Human leukocyte antigen (HLA) sensitization and ABO incompatibility. To overcome these barriers to transplant, strategies such as kidney paired donation (KPD) and desensitization have been developed. KPD is the exchange of donors between at least two incompatible donor-recipient pairs such that they are now compatible. Desensitization is the removal of circulating donor specific antibodies to prevent graft rejection. Regardless of the treatment strategy, highly sensitized patients whose calculated panel reactive antibody (cPRA) is ≥95% remain difficult to transplant with match rates as low as 15% in KPD pools. Desensitization has proved to be difficult in those with high antibody titers. A novel approach is the combination of both KPD and desensitization to facilitate compatible and successful transplantation. A highly sensitized patient can be paired with a better immunological match in the KPD pool and subsequently desensitized to a lesser degree. This article reviews the current progress in KPD and desensitization and their use as a combined therapy.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Abdominal Transplantation, Keck School of Medicine at University of Southern California, 1510 San Pablo St Suite 514, Los Angeles, CA 90033. Electronic address: Thomas.pham@med.usc.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Pham
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, 750 Welch Ave Suite 200, Palo Alto, CA 94304. Electronic address: Jlee26@stanford.edu.
authors.forename: Jacqueline I
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Department of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, 750 Welch Ave Suite 200, Palo Alto, CA 94304. Electronic address: melcherm@stanford.edu.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Melcher
mesh_terms: D003888:Desensitization, Immunologic / Q000379:methods*; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D011379:Prognosis; D014181:Transplantation Immunology / Q000502:physiology*; D016896:Treatment Outcome