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Kidney Paired Donation

Kidney Paired Donation. Michael A. Rees, M.D., Ph.D. Ohio Solid Organ Transplantation Consortium. OSOTC - Audrey B. Bohnengel, Ph.D. Children’s Hospital Cincinnati - Maria H. Alonso, M.D. Cleveland Clinic - David Goldfarb, M.D. Ohio State University - Mitchell L. Henry, M.D.

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Kidney Paired Donation

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  1. Kidney Paired Donation Michael A. Rees, M.D., Ph.D.

  2. Ohio Solid Organ Transplantation Consortium OSOTC - Audrey B. Bohnengel, Ph.D. Children’s Hospital Cincinnati - Maria H. Alonso, M.D. Cleveland Clinic - David Goldfarb, M.D. Ohio State University - Mitchell L. Henry, M.D. Miami Valley Hospital - Scott Johnson, M.D. University Hospital Cleveland - Mark Aeder, M.D. University of Cincinnati - E. Steve Woodle, M.D. Akron City Hospital (Summa) - Tanmay Lal, M.D. Anchor Enterprises - Alan Rees University of Cincinnati - Johnathan Kopke

  3. Other Contributors Harvard - Alvin Roth, Ph.D. Boston College - Tayfun Sönmez, Ph.D. University of Pittsburgh - Utku Ünver, Ph.D. Carnegie Mellon University - Tuomas Sandholm, Ph.D. Carnegie Mellon University – David Abraham, B.S. Johns Hopkins University - Robert Montgomery, M.D, D. Phil. Johns Hopkins University- Dorry Segev, M.D. Johns Hopkins University - Sommer Gentry, Ph.D. Columbia University - Lloyd Ratner, M.D. Massachusetts General Hospital - Frank Delmonico, M.D. University of North Carolina - Ken Andreoni, M.D.

  4. A Kidney Paired Donation Donor A Recipient A X Donor B Recipient B X

  5. A Paired Kidney Donation

  6. Strategy • 100 donor - recipient pairs generates • 4,950 potential paired exchanges.

  7. Potential Donations = n(n-1)/2

  8. Number of Pairs Required

  9. R = 0.114 Registrations per prior LRDs

  10. Point System Category Points 1. Wait time 2. Distance 3. Recipient vs. Donor Age Disparity 4. Donor vs. Donor Age Disparity 5. HLA Match 6. Pediatric Bonus 7. PRA Bonus 8. CMV/EBV Bonus 9. Blood Group A/B Bonus 3+ 5/2 3 2 6/2 6 6 2/2 6

  11. Data Entry Screens

  12. Medical Reviewer Screens

  13. All medically feasible matches from 41 pairs

  14. Optimizing matching of 8 pairs

  15. Number of transplants versus quality of the match 4 matches - 50 points 3 matches - 60 points

  16. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 2-way Solution

  17. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 3-way Solution

  18. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 4-way Solution

  19. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 Multiple Approach Solution

  20. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 Overall Crossmatches to perform

  21. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 With 3 x-matches positive

  22. 1 65 2 64 3 63 4 62 5 61 6 60 7 59 8 58 9 57 10 56 11 12 55 13 54 14 53 15 52 16 51 17 50 18 49 18 48 19 47 20 46 21 45 22 44 23 43 24 42 25 41 26 40 27 39 28 38 29 37 30 36 35 31 34 32 33 All but one 2-way match lost

  23. Results to Date • The Alliance for Paired Donation incorporated in August 2006 and began enrolling transplant centers in October 2006. • Currently over 70 transplant programs in 24 states participate and over 30 more are considering partnering with the APD. • Since March 2007, the APD has performed 32 paired donation transplants with 2 more scheduled. • In the January match run there were 145 pairs and we have found potential matches for 22 patients involving 12 transplant centers.

  24. Results to Date • Registered pairs ABOi = 60% , 40% crossmatch incompatible. • Registered candidates: PRA 80-100 % in 36%, 10-79% in 32 % and <10% in 29% • First 32 transplant recipients PRA 80-100 % in 22%, 50-79% in 19%, 25-49% in 22% and <25% in 38%. • Overall, 41% of the transplanted recipients had a PRA > 50%. • Registered candidates blood type: O in 53%, A in 25 %, B in 18% and AB in 4%. • First 32 transplant recipients blood type: O in 38%, A in 41 %, B in 19% and AB in 3%. • Donor blood type was O in 38%, A in 41%, B in 14% and AB in 8% of the first 32 donors.

  25. The Never-Ending Altruistic Donor Michael A. Rees, M.D., Ph.D.

  26. Paired Donation: Incompatible but willing living donors

  27. The square cannot give to the circle

  28. The circle cannot give to the square

  29. Paired Donation: The square gives to the square, the circle to the circle

  30. What if not done simultaneously?

  31. Reneging is possible – with loss of the “bargaining chip” of the incompatible donor’s kidney

  32. Common Situation: Not Reciprocal incompatibility

  33. Altruistic Donor Chain

  34. What if not done simultaneously?

  35. Reneging is possible – but the “bargaining chip” of the incompatible donor’s kidney is not lost. Therefore simultaneous procedures are NOT required.

  36. Simultaneous Altruistic Donor Chain Deceased Donor Waiting List

  37. Never-ending Altruistic Donor Start a new Altruistic Chain

  38. Never-ending Altruistic Donor continues

  39. Never-ending Altruistic Donor continues

  40. Never-ending Altruistic Donor

  41. The First Never-Ending Altruistic Donor Chain

  42. 1 2 14 3 13 4 12 5 11 6 10 7 9 8 Optimizing NEAD chain matching Each circle represents an incompatible donor/recipient pair

  43. 1 2 14 3 13 4 12 5 11 6 10 7 9 8 Who can donor 1 give to?

  44. 1 2 14 3 13 4 12 5 11 6 10 7 9 8 Who can donor 1 give to?

  45. 1 2 14 3 13 4 12 5 11 6 10 7 9 8 Who can donor 1 give to?

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