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Paired and AltruisticPaired and Altruistic
Kidney Donation InKidney Donation In
The UKThe UK
Deborah Green
North Bristol A...
ObjectivesObjectives
 Why this topic?
 Paired donation
 The process
 UK programme and problems
 Altruistic donation
...
Kidney DonationKidney Donation
 Types: DECEASED
LIVE
 Problems
1. ABO incompatibility
2. Presence of donor-specific
HLA ...
Paired DonationPaired Donation
Scheme run by BTS and UKT since 2007
DONOR 1 RECIPIENT 1
DONOR 2 RECIPIENT 2
The Matching ProcessThe Matching Process
Quarterly matching runs
Three stages:
Identify all possible two-way exchanges
D...
Identifying Optimum Transplant NumberIdentifying Optimum Transplant Number
Criteria Points
Location of pairs •Same area - ...
UK Programme Jan 2007 – Jan 2011UK Programme Jan 2007 – Jan 2011
465 patients enrolled
198 transplants identified
51% o...
Outcome of Identified TransplantsOutcome of Identified Transplants
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12 13 ...
Non-Proceeding TransplantsNon-Proceeding Transplants
Pos XM
38%
Alternative
transplant
20%
Donor or recipient
unfit
24%
Ot...
ExplanationsExplanations
Large proportion of highly sensitised
patients in UK cohort
◦ 97% UK
◦ 41% The Netherlands
(John...
SolutionsSolutions
1.Allowing compatible pairs to join the
paired scheme
• Simulation studies show up to 75%
increase in m...
Altruistic DonationAltruistic Donation
Individual live donors with no genetic or
personal link to a recipient.
60 altrui...
Altruistic DonationAltruistic Donation
0
200
400
600
800
1000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Altruistic...
Where Do They Fit in?Where Do They Fit in?
Donate to a recipient high on the
deceased waiting list
Donate to the paired ...
Domino-Paired DonationDomino-Paired Donation
• Two transplants take place
ReflectionReflection
 Potential for the paired scheme to help many
unmatched patients
 Making best use of altruistic don...
What the patients say...What the patients say...
‘...I was on dialysis for 5 years
before they finally found a
match. I ju...
ReferencesReferences
 Gentry SE, Montgomery RA, Segev DL. Kidney Paired Donation: Fundamentals, Limitations and Expansion...
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Paired and Altruistic Kidney Donation In The UK

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Paired and Altruistic Kidney Donation In The UK

  1. 1. Paired and AltruisticPaired and Altruistic Kidney Donation InKidney Donation In The UKThe UK Deborah Green North Bristol Academy
  2. 2. ObjectivesObjectives  Why this topic?  Paired donation  The process  UK programme and problems  Altruistic donation  Definition and development  Programmes worldwide  Patient views
  3. 3. Kidney DonationKidney Donation  Types: DECEASED LIVE  Problems 1. ABO incompatibility 2. Presence of donor-specific HLA antibodies
  4. 4. Paired DonationPaired Donation Scheme run by BTS and UKT since 2007 DONOR 1 RECIPIENT 1 DONOR 2 RECIPIENT 2
  5. 5. The Matching ProcessThe Matching Process Quarterly matching runs Three stages: Identify all possible two-way exchanges Determine all combinations of exchange Identify optimum combinations
  6. 6. Identifying Optimum Transplant NumberIdentifying Optimum Transplant Number Criteria Points Location of pairs •Same area - 20 •Otherwise - 0 HLA Match •Level 1 – 15 •Level 4 – 0 Sensitisation •0 – 50 points Donor – donor age difference •< 20 years – 3 points •> 20 years – 0 points Blood group matching •O donors reserved for O recipients
  7. 7. UK Programme Jan 2007 – Jan 2011UK Programme Jan 2007 – Jan 2011 465 patients enrolled 198 transplants identified 51% of identified transplants have not taken place
  8. 8. Outcome of Identified TransplantsOutcome of Identified Transplants 0 5 10 15 20 25 30 35 40 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Not proceeding Transplant No. of potential transplants Matching runApr 2007 Jan 2011 (Data from UKT)
  9. 9. Non-Proceeding TransplantsNon-Proceeding Transplants Pos XM 38% Alternative transplant 20% Donor or recipient unfit 24% Other 18% (Data from UKT)
  10. 10. ExplanationsExplanations Large proportion of highly sensitised patients in UK cohort ◦ 97% UK ◦ 41% The Netherlands (Johnson et al 2008) Blood type skewing ◦ 50% of pairs with blood type O recipients ◦ 30% of pairs with blood type O donors (15% match rate for O recipients currently) (Johnson et al 2008)
  11. 11. SolutionsSolutions 1.Allowing compatible pairs to join the paired scheme • Simulation studies show up to 75% increase in match rate for O recipients (Gentry et al. 2007) 2.Combining desensitisation with paired donation • Complimentary modalities in the US for difficult to match patients. (Segev et al. 2008)
  12. 12. Altruistic DonationAltruistic Donation Individual live donors with no genetic or personal link to a recipient. 60 altruistic donations in the UK to date
  13. 13. Altruistic DonationAltruistic Donation 0 200 400 600 800 1000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Altruistic donor (non-directed) Paired exchange donor ABO incompatible donor HLA incompatible donor Unrelated donor (directed) Related donor (Data from UKT) Tx N◦ Year
  14. 14. Where Do They Fit in?Where Do They Fit in? Donate to a recipient high on the deceased waiting list Donate to the paired donor scheme ◦ Transplant numbers increased 1.6 times per altruistic donor (Roodnat et al 2010)
  15. 15. Domino-Paired DonationDomino-Paired Donation • Two transplants take place
  16. 16. ReflectionReflection  Potential for the paired scheme to help many unmatched patients  Making best use of altruistic donors  MDT involvement at many levels  Impact on lives of patients
  17. 17. What the patients say...What the patients say... ‘...I was on dialysis for 5 years before they finally found a match. I just wanted to die in my sleep...’ ‘ You feel so helpless. He was so ill and I wasnt able to do anything but wait...’ Any Questions?
  18. 18. ReferencesReferences  Gentry SE, Montgomery RA, Segev DL. Kidney Paired Donation: Fundamentals, Limitations and Expansions. American Journal of Kidney Diseases. 2011; 57(1): 144-151  Johnson RJ, Allen JE, Fuggle SV, Bradley JA, Rudge C. Early Experience of Paired Living Kidney Donation In The UK. Transplantation. 2008; 86(12): 1672-1677  Mongomery RA, Renal Transplantation Across HLA and ABO Antibody Barriers: Integrated Paired Donation Into Desensitisation Protocols. American Journal of Transplantation. 2010; 10: 449-457  Rapaport FT. The case for a living emotionally related international kidney donor exchange registry. Transplant Proc. 1986; 18: 5  Kwak JY, Kwon OJ, Lee KS et al. Exchange-donor program in renal transplantation: A single centre experience. Transplant Proc. 1999; 31: 344  Johnson RJ et al. Paired and Altruistic Non-Directed Living Kidney Donation. Renal Transplant Services Meeting January 2011. Accessed March 2011  Segev DL, Kucirka LM, Gentry SF, Montgomery RA. Utilisation And Outcomes Of Kidney Paired Donation In the US. Transplantation. 2008; 86: 502-510  Gentry SE, Segev DL, Simmerling M, Mongomery RA. Expanding Kidney Paired Donation Through Participation By Compatible Pairs. American Journal of Transplantation. 2007; 7: 2361-2370  Gentry SE, Montgomery RA, Swihart BJ, Segev DL. The roles of dominos and never-ending altruistic donor chains in kidney paired donation. American Journal of Transplantation. 2009; 9: 1330-1336  The National Matching Scheme For Paired Donation. Available at www.bts.org.uk. Accessed March 2011  UK Transplant. Available at www.uktransplant.org.uk. Accessed February 2011

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