Ten Years of Kidney Paired Donation at Mayo Clinic: The Benefits of Incorporating ABO/HLA Compatible Pairs

Transplantation. 2020 Jun;104(6):1229-1238. doi: 10.1097/TP.0000000000002947.

Abstract

Background: We examined the 10-year experience of Mayo Clinic's kidney paired donation (KPD).We aimed to determine the benefits for the recipients of enrolled ABO/HLA compatible pairs and determine the factors associated with prolonged KPD waiting time.

Methods: We performed a retrospective study of 332 kidney transplants facilitated by the Mayo 3-site KPD program from September 2007 to June 2018.

Results: The median (interquartile range) time from KPD entry to transplantation was 89 days (42-187 days). The factors independently associated with receiving a transplant >3 months after KPD entry included recipient blood type O and calculated panel reactive antibodies ≥98%. Fifty-four ABO/HLA compatible pairs participated in KPD for the following reasons: cytomegalovirus mismatch (18.5% [10/54]), Epstein-Barr virus (EBV) mismatch (EBV) (9.3% [5/54]), age/size mismatch (51.9% [28/54]), or altruistic reasons (20.3% [11/54]). Cytomegalovirus and EBV mismatch were avoided in 90% (9/10) and 100% (5/5) of cases. Recipients who entered KPD for age/size mismatch and altruistic reasons received kidneys from donors with lower Living Kidney Donor Profile Index scores than their actual donor (median [interquartile range] 31.5 [12.3-47]; P < 0.001 and 26 (-1 to 46); P = 0.01 points lower, respectively). Median time to transplant from KPD entry for compatible pair recipients was 70 days (41-163 days), and 44.4% (24/54) of these transplants were preemptive. All chains/swaps incorporating compatible pairs included ABO/HLA incompatible pairs.

Conclusions: KPD should be considered for all living donor/recipient pairs because the recipients of these pairs can derive personal benefit from KPD while increasing the donor pool for difficult to match pairs.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • ABO Blood-Group System / immunology
  • Adult
  • Aged
  • Altruism
  • Donor Selection / methods*
  • Donor Selection / organization & administration
  • Donor Selection / statistics & numerical data
  • Female
  • Graft Rejection / epidemiology*
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control
  • HLA Antigens / immunology
  • Histocompatibility Testing / statistics & numerical data
  • Humans
  • International Cooperation
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Kidney Transplantation / statistics & numerical data
  • Living Donors / psychology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Time Factors
  • Time-to-Treatment / statistics & numerical data
  • Transplant Recipients / psychology
  • Treatment Outcome

Substances

  • ABO Blood-Group System
  • HLA Antigens