P229 Getting renal alternative through paired exchange in Hong Kong

Aim Kidney transplantation is regarded as the most cost-effective modality of kidney replacement therapy for end stage kidney diseases. In Hong Kong, there are more than two thousand patients awaiting kidney transplantation with only less than 80 patients who can either obtain their kidney graft from deceased or living donor annually. As the demand for a kidney graft exceeds the supply, alternative source of these precious grafts is sought. The feasibility of paired exchange for patients who have a potential live donor but could not proceed for living kidney transplant because of either ABO incompatibility or positive cross-match has been investigated with the lessons learned from other countries [1] , [2] . Virtual match run for these patients to search for compatible match of two or more possibilities of transplant by exchanging donors has been performed. Methods Crossmatch results for living-related renal transplantation workup in 2012–2013 were reviewed for this feasibility study. 88 potential donor-recipient pairs comprise of 78 patients and 88 donors were included, 10 pairs (11.4%) were found to have positive crossmatch after reviewing the clinical and laboratory data. Results HLA typing, blood group, age, list of unacceptable antigens of each recipient were entered into a database together with their potential donors’ blood group and HLA typing for the match run in order to search for the best possible combination of compatible pairs. Multiple permutations of donor exchange including simple two-way and domino-pair exchange has been considered to accommodate the most number of recipients. An optimal compatible chain for the 7 donor-recipient pairs was obtained, including 1 simple two-pair exchange and a more complicated domino exchange chain donation consists of 5 donor-recipient pairs. Conclusions This virtual work up feasibility test provides evidence to prove that paired exchange of kidney transplant could facilitate compatible kidney transplants and target at creating legitimate, safe and effective transplant opportunities for eligible candidates in Hong Kong. Further study including discussion on legal and ethical aspect for the equity, justice, altruism and informed consent of the prospective pairs should be sought.