Department of Medicine, Emory Transplant Center, Emory University School of Medicine, Atlanta, GA.
Mayo Clinic William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
Transplantation. 2020 Jun;104(6):1229-1238. doi: 10.1097/TP.0000000000002947.
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.
We performed a retrospective study of 332 kidney transplants facilitated by the Mayo 3-site KPD program from September 2007 to June 2018.
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.
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.
我们研究了梅奥诊所肾脏配对捐赠（KPD）的 10 年经验。我们旨在确定纳入 ABO/HLA 相容对的受者的获益，并确定与 KPD 等待时间延长相关的因素。
我们对 2007 年 9 月至 2018 年 6 月期间，由梅奥 3 个地点 KPD 计划促成的 332 例肾脏移植进行了回顾性研究。
从 KPD 进入到移植的中位数（四分位距）时间为 89 天（42-187 天）。在 KPD 进入后 3 个月以上接受移植的独立相关因素包括受者血型为 O 型和计算的 panel reactive antibodies≥98%。54 对 ABO/HLA 相容对参与 KPD 的原因如下：巨细胞病毒不匹配（18.5%[10/54]）、EBV 不匹配（9.3%[5/54]）、年龄/大小不匹配（51.9%[28/54]）或利他原因（20.3%[11/54]）。90%（9/10）和 100%（5/5）的巨细胞病毒和 EBV 不匹配病例避免了不匹配。因年龄/大小不匹配和利他原因进入 KPD 的受者接受的肾脏来自供者的 Living Kidney Donor Profile Index 评分低于其实际供者（中位数[四分位距]31.5[12.3-47]；P<0.001 和 26（-1 至 46）；P=0.01 分更低）。从 KPD 进入到相容对受者移植的中位数时间为 70 天（41-163 天），其中 44.4%（24/54）的移植为抢先移植。所有纳入相容对的链/交换都包括 ABO/HLA 不相容对。
应考虑为所有活体供者/受者对进行 KPD，因为这些对的受者可以从 KPD 中获得个人获益，同时增加了难以匹配对的供者池。
