Identifying Opportunities to Increase the Throughput of Kidney Paired Donation. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Liu, Wenhao; Treat, Eric; Veale, Jeffrey L.; Milner, John; Melcher, Marc L.
• Is Part Of: Transplantation. Volume 99:Issue 7(2015)
• Publication Date: 2015-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000527
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Although kidney paired donation (KPD) has led to thousands of transplants, the 2012 KPD Consensus Conference concluded that more could be done. Perceptions are that a large number of match offers never resulted in transplantations, and unfruitful matches have both financial and emotional costs. Methods: To describe, quantify, and analyze the unrealized match offers, we studied the matching process from registration to transplantation in the National Kidney Registry, a large KPD registry, over a 25-month period. Results: Of the 3, 180 match offers, 454 were turned down. The most common reasons were the donor was not acceptable (50%) and their recipient had unacceptably high donor-specific antibodies (28%). Of the 2, 228 accepted offers, 1, 335 advanced to the cell-based cross-match stage because 893 of these were part of chains that fell through. Fifty-five of 887 recorded cell-based cross-matches were positive, 20 donors were unacceptable, and 22 recipients had unacceptably high donor-specific antibodies. Six hundred ninety transplantations were performed. Conclusion: Despite the success of KPD, by analyzing the matching process, we identify several strategies to increase the number of KPD transplantations, including recruiting more participants, processing the match offers more quickly at the transplant center level, enhancing the donor preselection tools, improving communication between centers and the registries, and combining desensitization with KPD. Abstract : This large retrospective analysis of reasons for failure to finalize potential kidney paired donations identifies several variables that are barriers to transplantation, most prominently positive cross matches. The analysis leads to several strategies to streamline crossmatching and communication in order to enhance rapid decision making and avoid positive cross matches.