Comparison of time on the deceased donor kidney waitlist versus time on the kidney paired donation registry in the Australian program

Abstract

Summary In the Australian kidney paired donation (KPD) program matching is based on acceptable mismatches, whereas deceased donor waitlist (DDWL) patients are allocated kidneys based on HLA antigen matching rules. Herein, we compared waiting time for a KPD match to the waiting time on the DDWL and the occurrence of matching in the DDWL for patients who were registered in both programs. Data on first dialysis, matches on the DDWL, KPD program entry, matches and transplant dates were assessed in 26 KPD recipients of the Australian program. There were 22 recipients who were listed in the DDWL and received kidney transplants by KPD. Time on dialysis until KPD transplantation was 808 ± 646 days. Eleven patients had never been matched with a deceased donor (waiting time 345 ± 237 days) and 11 had been matched on average 3 ± 5 times (waiting time 1227 ± 615 days, P < 0.0001 vs. never matched), but did not progress to transplantation because of positive crossmatch or class II donor‐specific antibody. Mean time from registration in the KPD program until kidney transplantation was 153 ± 92 days (P < 0.0001 vs. DDWL). KPD allocation using the acceptable mismatch approach is effective in identifying suitable live donors for some recipients within a relatively short time‐frame.

Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program

“…However, considerable controversy remains regarding the best practices for accomplishing this goal (15)(16)(17)22,23). This report demonstrates that virtual crossmatches can be used to reliably predict acceptable cell-based crossmatches and a large number of transplants can be achieved by allowing each transplant center to establish criteria for assigning unacceptable antigens and acceptable crossmatches.…”

“…For example, the Australian National Exchange program used 2000 MFI to assign unacceptable antigens, but no compatible donors were identified in four quarterly match runs (16,22,23). The likelihood of a match was improved by increasing the threshold to 8000 MFI, but patients with even higher levels of DSAs can be successfully transplanted (18,19).…”

Facilitators to national kidney paired donation program

“…Sirs, We read with great interest the report by Ferrari P, et al [1] Recent study results are valuable for encouraging participation of kidney paired donation (KPD) pairs and transplant centers in national KPD program [1][2][3][4][5][6][7]. We believe that with some additions scientific value and contribution of the article may result into wider implementation of KPD.…”

“…Extrapolating these levels of willingness nationally; 1-11% increase in living donation rates yearly may be possible if donor-exchange programs were available nationwide [7]. Comparatively short waiting time in KPD [1] will save the cost of maintenance dialysis and associated morbidity and mortality. The constraints in operating an effective maintenance dialysis program leave RTx as the only viable option for patients with ESRD in developing countries like India.…”

Equipoise: Ethical, Scientific, and Clinical Trial Design Considerations for Compatible Pair Participation in Kidney Exchange Programs

“…After the initial description of the ethical and scientific principles for kidney exchange (8), the field has progressively expanded, with several nationally based kidney exchange programs established over the past several years, including the Dutch, Australian, Canadian, and British programs (9)(10)(11). A single US kidney exchange program, the National Kidney Registry, facilitated over 300 KE transplants in 2013.…”