Ten Years of Kidney Paired Donation at Mayo Clinic: The Benefits of Incorporating ABO/HLA Compatible Pairs

BACKGROUND: 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. METHODS: We performed a retrospective study of 332 kidney transplants facilitated by the Mayo 3-site KPD program from 9/2007- 6/2018. RESULTS: The median (IQR) time from KPD entry to transplantation was 89(42-187) days. The factors independently associated with receiving a transplant > 3 months after KPD entry included recipient blood type O and cPRA (calculated panel reactive antibodies) ≥ 98%. Fifty-four ABO/HLA compatible pairs participated in KPD for the following reasons: CMV mismatch [18.5 %(10/54)], EBV mismatch (EBV) [9.3 %(5/54)], age/size mismatch [51.9 %(28/54)] or altruistic reasons [20.3 %(11/54)]. CMV and EBV mismatch was 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 (LKDPI) scores than their actual donor [median (IQR) 31.5(12.3, 47) p<.001, and 26(-1, 46), p=0.01 points lower, respectively]. Median time to transplant from KPD entry for compatible pair recipients was 70(41-163) days, and 44.4 %(24/54) of these transplants were preemptive. All chains/swaps incorporating compatible pairs included ABO/HLA incompatible pairs. CONCLUSION: 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.