1 William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN. 2 Mayo Clinic Arizona Transplant Center, Mayo Clinic, Phoenix, AZ. 3 Department of Transplantation, Mayo Clinic, Jacksonville, FL. 4 Division of Transfusion Medicine, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN. 5 Address correspondence to: Mark D. Stegall, M.D., Division of Transplantation Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Transplantation. 2014 Aug 15;98(3):300-5. doi: 10.1097/TP.0000000000000054.
Kidney paired donation (KPD) has emerged as a viable option for renal transplant candidates with incompatible living donors. The aim of this study was to assess the "performance" of a three-site KPD program that allowed screening of multiple donors per recipient.
We reviewed retrospectively the activity of our KPD program involving three centers under the same institutional umbrella. The primary goal was to achieve a transplant that was both ABO compatible and had a negative or low-positive flow cytometric crossmatch (+XM).
During the 40-month study period, 114 kidney transplant candidates were enrolled-57% resulting from a +XM and 39% resulting from ABO incompatible (ABOi) donors. Important outcomes were as follows: (1) 81 (71%) candidates received a transplant and 33 (29%) were still waiting; (2) 368 donors were evaluated, including 10 nondirected donors; (3) 82% (37/45) of ABOi candidates underwent transplantation; (4) 56% (36/65) of +XM candidates underwent transplantation (however, all but four of these had a cPRA less than 95%); (5) at the end of the study period, 97% (28/29) of +XM candidates still waiting had a cPRA greater than 95%.
These data suggest evaluating large numbers of donors increases the chances of KPD. Patients with a cPRA greater than 95% are unlikely to receive a negative or low-positive +XM, suggesting the need for desensitization protocols in KPD.
对于与活体供者不相容的肾移植受者，肾对配对捐赠（KPD）已成为一种可行的选择。本研究旨在评估允许对每位受者筛选多位供者的三站点 KPD 方案的“表现”。
我们回顾性地审查了我们的 KPD 计划的活动，该计划涉及同一机构下的三个中心。主要目标是实现 ABO 相容且流式细胞交叉配型（XM）阴性或弱阳性的移植。
在 40 个月的研究期间，有 114 名肾移植候选者入组，其中 57%是由于 XM 阳性，39%是由于 ABO 不相容（ABOi）供者。重要的结果如下：（1）81 名（71%）候选者接受了移植，33 名（29%）仍在等待；（2）评估了 368 名供者，包括 10 名非定向供者；（3）82%（37/45）的 ABOi 候选者接受了移植；（4）56%（36/65）的 XM 阳性候选者接受了移植（但是，除了四人之外，他们的 cPRA 均小于 95%）；（5）在研究期末，97%（28/29）仍在等待的 XM 阳性候选者的 cPRA 大于 95%。
这些数据表明，评估大量供者可增加 KPD 的机会。cPRA 大于 95%的患者不太可能获得阴性或弱阳性的 XM，这表明 KPD 需要脱敏方案。
