Assessing the efficacy of kidney paired donation--performance of an integrated three-site program

Transplantation. 2014 Aug 15;98(3):300-5. doi: 10.1097/TP.0000000000000054.


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.

MeSH terms

  • ABO Blood-Group System / immunology
  • Adult
  • Aged
  • Blood Group Incompatibility / immunology
  • Female
  • Graft Survival
  • Histocompatibility Testing
  • Humans
  • Isoantibodies / blood
  • Kidney Transplantation* / mortality
  • Living Donors*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Waiting Lists


  • ABO Blood-Group System
  • Isoantibodies