Kidney Paired Donation and Optimizing the Use of Live Donor Organs

Segev, Dorry L.; Gentry, Sommer E.; Warren, Daniel; Reeb, Brigitte; Montgomery, Robert A.

doi:10.1001/jama.293.15.1883

Cited by 379 publications

(330 citation statements)

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“…A donor and recipient who have incompatible blood groups or HLA sensitivity can be matched with another incompatible pair, to result in two compatible transplants (fi gure). [13][14][15][16][17][18][19] Although there are many ways to match up a pool of incompatible pairs, the mathematical technique of optimisation helps to fi nd out which matches will yield the best results. 13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched.…”

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confidence: 99%

“…[13][14][15][16][17][18][19] Although there are many ways to match up a pool of incompatible pairs, the mathematical technique of optimisation helps to fi nd out which matches will yield the best results. 13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched. 13,20 In many cases, pools of incompatible donor-recipient pairs have a high proportion of patients with blood types that are hard to match and those with HLA sensitisation.…”

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confidence: 99%

“…13 Nevertheless, even in paired-donation programmes in which mathematical optimisation is applied, more than 50% of the incompatible pairs in the pool remain unmatched. 13,20 In many cases, pools of incompatible donor-recipient pairs have a high proportion of patients with blood types that are hard to match and those with HLA sensitisation.…”

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confidence: 99%

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Domino paired kidney donation: a strategy to make best use of live non-directed donation

et al. 2006

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Domino paired kidney donation: a strategy to make best use of live non-directed donation

et al. 2006

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“…Around a third of adults presenting for transplantation have an antibody incompatibility [1] and the number of HLAi renal transplants in adults has risen significantly in the last decade [2]. However, the number of children undergoing renal transplantation when the baseline cross-match is positive has remained largely unchanged; indeed, the United Network for Organ Sharing (UNOS) data shows no increase in deceased donor transplantation rates in children with panel reactive antibody (PRA) > 98 % from 2004 to 2014, but a quadrupling in transplantation rates in those with little or no antibody [3].…”

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confidence: 99%

Desensitization protocols for prospective pediatric renal transplant recipients

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Marks

2016

Pediatr Nephrol

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Desensitization protocols should be considered for children with positive crossmatches awaiting renal transplantation. Children are sensitized usually due to previous renal (and/or other solid-organ) transplants but can be from administration of blood and/or platelet transfusions, infections, and immunizations (as sensitization from pregnancy is a rare occurrence in pediatric patients). However, the definition of HLA-incompatible (HLAi) renal transplantation in the literature varies and is best considered only when there is a positive cross-match (positive baseline flow cytometric cross-match or positive complement-dependent cytotoxic cross-match). Renal transplantation where the recipient has donor-specific antibodies (DSA) but a negative cross-match should not fall into this category, although they are higher risk.

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“…If the person providing the education were not informed about this change, HIV-positive patients might simply be told they were ineligible and never seek or attain access. Similarly, over the past decade, there have been major advances in KT for pediatric patients (14), those aged .65 years (15), obese patients (7,16), and patients with donors incompatible by HLA or blood type, both by desensitization (17,18) and kidney exchange (19). In addition, much more is known today about the incremental risks of live donation (20)(21)(22).…”

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confidence: 99%