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Optimizing Outcomes in Pediatric Renal Transplantation Through the Australian Paired Kidney Exchange Program
Author(s) -
Sypek M. P.,
Alexander S. I.,
Cantwell L.,
Ierino F. L.,
Ferrari P.,
Walker A. M.,
Kausman J. Y.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14041
Subject(s) - medicine , abo incompatibility , kidney transplantation , donation , histocompatibility , transplantation , abo blood group system , intensive care medicine , human leukocyte antigen , immunology , antigen , economics , economic growth
Kidney paired donation ( KPD ) programs offer the opportunity to enable living kidney donation when immunological and other barriers prevent safe directed donation. Children are likely to require multiple transplants during their lifetime; therefore, high‐level histocompatibility and organ quality matching are key priorities. Details are given for a cohort of seven pediatric renal transplantations performed through the Australian Kidney Exchange ( AKX ), including barriers to alternative transplantation and outcomes after KPD . Reasons for entering the KPD program were preformed donor‐specific antibodies to their registered donor in five cases, ABO mismatch, and avoidance of the risk of exposure to hepatitis B virus. Four recipients were highly sensitized. All patients received transplants with organs of lower immunological risk compared with their registered donors. HLA eplet mismatch scores were calculated for donor–recipient pairs; three patients had improved eplet mismatch load with AKX donor compared with their registered donor. All grafts are functioning, with a mean estimated glomerular filtration rate of 77 mL /min/1.73 m 2 (range 46–94 mL ) and a follow‐up range of 8–54 months, and no patient experienced clinical or histological rejection. KPD is a viable strategy to overcome many barriers to living donation for pediatric patients who have an otherwise suitable donor and provides an opportunity to minimize immunological risks.