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Aim Kidney paired donation (KPD) is an effective way to transplant patients with willing but incompatible donors. We report our experience with KPD through development of local Registry for incompatible pairs. Methods 62 recipients & their incompatible donors plus 3 non-directed donors were entered into KPD registry. Incompatibility was due to ABO-incompatibility (ABOi) in 25% & HLA-incompatibility (HLAi) in 75%. Patients with HLAi had cPRA between 60–99%. Antibodies with MFI of ⩾ 3000 by SAB assay were listed as unacceptable antigens. We used balanced, unbalanced & non-directed anonymous donors (NDAD). ABOi donors were accepted if patients had low titer ( ⩽ 16) of Isohemagglutinins. Amenable DSA for desensitization are those weak, single or multiple that yielded negative or weakly positive flow cross match ( Results 23 candidates (37%) were transplanted, enabling pre-emptive transplant in 1 patient. The longest chain was seven -ways domino chain initiated by a NDAD & ended in transplant of deceased donor listed patient with multiple access failure. Additional desensitization was used for 9 patients due to DSA and/ or positive FXM. 1 patient received TPE due to anti ABO antibody titer of 16. We had one case of DGF, AMR occurred in 2 patients & 1 patient had ACR. Graft function was good through follow-up time of 6–18 months but one patient died 8 months post-transplant due to refractory sepsis. Conclusions Although our series is early with 62 patients, transplant rate is excellent compared to other old programs(Netherlands, UK, & Canada) where the transplant rate were 37%, 29%, 44% respectively. This might be attributed to involving NDAD, accepting ABOi & combining desensitization for low level DSA in selected patients. Considering that 75% of the patients were highly sensitized yet received living transplants with excellent results, our experience demonstrates promising short-term outcomes. However, longer follow-up is needed to assess the impact of KPD on organ shortage & the outcome of highly sensitized patients transplanted through KPD program. |
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