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Title: ABO-incompatible matching significantly enhances transplant rates in kidney paired donation.
Authors: Cohney, Solomon (Shlomo)
Other Authors: Ferrari, P.
Hughes, Peter
Woodroffe, C.
Fidler, S.
D'Orsogna, L.
Keywords: ABO Blood-Group System
Blood Group Incompatibility
Blood Grouping and Crossmatching
Computer Simulation
Donor Selection
HLA Antigens
Kidney Transplantation
Tissue Donors
Treatment Outcome
Donor Specific Anti-Human Leukocyte Antigen Antibodies
Plasmapheresis-Based Strategies
Kidney Paired Donation
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Nephrology, Epworth HealthCare, Richmond, Victoria, Australia.
Issue Date: Nov-2013
Publisher: Wolters Kluwer
Citation: Transplantation. 2013 Nov 15;96(9):821-6
Abstract: BACKGROUND: Although preformed donor-specific anti-human leukocyte antigen antibodies (DSA) can be overcome by plasmapheresis-based strategies with some success in renal transplantation, kidney paired donation (KPD) is a more effective strategy to avoid DSA. In contrast, ABO incompatibility can be crossed with outcomes equivalent to ABO-compatible transplantation. Here, we report the ability of accepting human leukocyte antigen-compatible but ABO-incompatible donors to increase the number of exchanges in a KPD program. METHODS: In the Australian KPD program, virtual crossmatch is used to allocate suitable donors to recipients. Acceptance of ABO-incompatible donors is allowed in cases where anti-blood group antibody titres are deemed amenable to removal by apheresis or immunoabsorption. The number of matched recipients, identified chains, and transplants performed with and without acceptance of ABO incompatibility was analyzed. RESULTS: In 2 years, 115 pairs were included in nine quarterly match runs. Incompatibility due to DSA accounted for 86% of the listed pairs and 52% were also blood group incompatible to their coregistered donor. Median calculated panel-reactive antibody in registered recipients was 83% (mean, 67%±37%). ABO-incompatible donors were accepted for 36 patients. Two waitlist recipients and 48 KPD candidates were matched and transplanted. Ten recipients (20%) of an ABO-incompatible donor kidney were distributed across 8 chains that resulted in 21 recipients being transplanted. Thus, without ABO-incompatible matching, only 27 recipients in 12 chains would have been transplanted. CONCLUSION: Acceptance of blood group-incompatible donors for patients with low to moderate anti-blood group antibody significantly increases transplant rates for highly sensitized recipients.
DOI: 10.1097/TP.0b013e3182a01311
PubMed URL:
ISSN: 1534-6080
Journal Title: Transplantation.
Type: Journal Article
Affiliated Organisations: Department of Nephrology, Fremantle Hospital, Perth, Western Australia, Australia
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Nephrology, Western Hospital, Footscray, Victoria, Australia
University of Melbourne, Melbourne, Victoria, Australia
Department of Immunology, PathWest, Royal Perth Hospital, Perth, Western Australia, Australia
School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
Type of Clinical Study or Trial: Predictive Value of Tests
Appears in Collections:UroRenal, Vascular

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