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. 2011 Aug;6(8):2041-6.
doi: 10.2215/CJN.02940311. Epub 2011 Jul 22.

Incompatible live-donor kidney transplantation in the United States: results of a national survey

Jacqueline M Garonzik Wang  1 , Robert A Montgomery, Lauren M Kucirka, Jonathan C Berger, Daniel S Warren, Dorry L Segev
Affiliations

Incompatible live-donor kidney transplantation in the United States: results of a national survey

Jacqueline M Garonzik Wang et al. Clin J Am Soc Nephrol. 2011 Aug.

Abstract

Background and objectives: Use of incompatible kidney transplantation (IKT) is growing as a response to the organ shortage and the increase in sensitization among candidates. However, recent regulatory mandates possibly threaten IKT, and the potential effect of these mandates cannot be estimated because dissemination of this modality remains unknown. The goal of this study was to better understand practice patterns of IKT in the United States.

Design, setting, participants, & measurements: Directors from all 187 unique active adult kidney transplant programs were queried about transplantation across the following antibody barriers: positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); positive cytotoxic crossmatch (PCC); and ABO incompatible (ABOi).

Results: Responses from 125 centers represented 84% of the live-donor transplant volume in the United States. Barriers of PLNF, PFNC, PCC, and ABOi are being crossed in 70%, 51%, 18%, and 24%, respectively, of transplant centers that responded. Desensitization was performed in 58% of PLNF, 76% of PFNC, 100% of PCC, and 80% of ABOi using plasmapheresis and low-dose intravenous Ig (IVIg) in 71% to 83% and high-dose IVIg in 29% to 46%.

Conclusions: A higher proportion of centers perform IKT than might be inferred from the literature. The rapid dissemination of these protocols despite adequate evidence of a clear advantage of IKT transplants argues for the creation of a national registry and randomized studies.

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Figures

Figure 1.
Figure 1.
Proportion of transplant centers in the United States performing incompatible kidney transplants by level of incompatibility. The upper and lower bounds represent the percentages of centers performing each type of transplant had all of the nonrespondents performed that type of transplant (upper bounds, “Max %”) or had all nonrespondents not performed that type of transplant (lower bounds, “Min %”). The central dot represents the observed percentage of respondents that performed that type of transplant. PLNF, positive Luminex DSA/negative flow cytometric crossmatch; PFNC, positive flow cytometric crossmatch/negative cytotoxic crossmatch; PCC, positive cytotoxic crossmatch; ABOi, ABO incompatible.
See this image and copyright information in PMC

References

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