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

Arpita Basu, Mike Prieto, Catherine Kosberg, Martin L. Mai, Hasan Ahmad Khamash, Caroline C. Jadlowiec, Naim S. Issa, Patrick G. Dean, Elizabeth C Lorenz, Mark D. Stegall, Carrie A. Schinstock

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1229-1238
Number of pages10
JournalTransplantation
DOIs
StateAccepted/In press - Jan 1 2020

ASJC Scopus subject areas

  • Transplantation

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    Basu, A., Prieto, M., Kosberg, C., Mai, M. L., Khamash, H. A., Jadlowiec, C. C., Issa, N. S., Dean, P. G., Lorenz, E. C., Stegall, M. D., & Schinstock, C. A. (Accepted/In press). Ten Years of Kidney Paired Donation at Mayo Clinic: The Benefits of Incorporating ABO/HLA Compatible Pairs. Transplantation, 1229-1238. https://doi.org/10.1097/TP.0000000000002947