DOCSLIB.ORG

Transplant Digest Fall 2020

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Transplant Digest Fall 2020 FALL 2020 TRANSPLANTdigest A BI-ANNUAL PUBLICATION OF MEDSTAR GEORGETOWN TRANSPLANT INSTITUTE Hepatitis C Positive Organs Increase Access to Transplant The wait time for an organ transplant can be significant, ranging from months to years. For patients in need of kidney or liver transplant, one extremely effective approach to shortening wait times is the use of living donor organs. Another newer strategy to further expand organ supply is the use of hepatitis C positive organs from living or deceased donors in patients who do not have the disease. A revolution in the treatment of hepatitis C has allowed physicians to cure the disease with medications Jason Hawksworth, MD, performs surgery using the da Vinci® robot. continued on page 9 Clinical Spotlight: Robotic Liver and Pancreas Surgery MedStar Georgetown Transplant hepatopancreaticobiliary surgeries in Institute is home to one of the only the country.” programs in the country that offers robotic liver and pancreas resection for Prior to the robotic surgical option benign and malignant tumors of the being available, a laparoscopic liver, pancreas, and bile ducts. approach was the only minimally invasive surgical option. While Notes Jason Hawksworth, MD, that approach offered many chief of Robotic Surgery at MedStar patient benefits, there was still a Georgetown Transplant Institute, large volume of cases, about 40 to “Currently, 90 percent of our practice 50 percent, that could not be is focused on robotic surgeries, performed laparoscopically. Robotic and we performed 100 robotic surgery allows us to extend the benefits resections during the last calendar of a minimally invasive approach to a year—the highest volume of robotic broader population of patients. continued on page 9 IN THIS ISSUE 2 Letter From the Executive Director 4 Simultaneous Pancreas and Kidney 6 Living Liver Donor Program Transplantation Yields Better Outcomes 2 New Safety Protocol Allowed MedStar Increases Access to Transplantation for Diabetics Georgetown Transplant Institute to Perform 7 MedStar Georgetown Transplant Institute More Kidney Transplants Than Any Other U.S. 5 Can Pediatric Liver Transplant Patients Expect is Largest Center of Minor Blood Group Hospital During Pandemic’s Height a Normal Life Expectancy? Incompatible Transplants 3 Paired Kidney Exchange Markedly Increases 5 Inflammasome Activation Linked to Poor 8 Meet Our New Physicians Number of Transplants Outcomes in Comorbid COVID-19 Patients 10 By the Numbers: MedStar Georgetown’s Transplant Programs LETTER FROM THE EXECUTIVE DIRECTOR New Safety Protocol Allowed MedStar Georgetown Transplant Dear Colleague, Institute to Perform More Kidney Transplants Than Any Other U.S. What an extraordinary time we are Hospital During Pandemic’s Height living in. The COVID-19 pandemic hit the MedStar Georgetown Transplant During the height of the COVID-19 Institute as it did everyone, bringing dramatic changes and raising questions pandemic (March through May), MedStar never before faced. We began to see Georgetown Transplant Institute performed patients with transplants and cancer more kidney transplants than any other presenting to the hospital with severe hospital in the U.S., and successfully COVID-19 in March. Immediately, safeguarded all transplant recipients and we recognized we needed to pivot living donors from contracting COVID-19. from our current clinical strategy and See our March through August volumes research and undertake a redesign of chart on page 12. our approach to care. Transplant programs across the nation From March to May, the Institute performed were shutting down, temporarily expression of caspase-1 and other 115 organ transplants—90 of which inactivating their patient listings, and markers of pyroptosis appeared to were kidney transplants with 23 of these many suggested we could not provide be present among liver and kidney transplants involving living donors. This transplants until the pandemic passed. disease patients. These were further record number is nearly equal to the total But our patients with organ failure and upregulated when COVID-19 hit, number of transplants performed by all cancer faced a higher risk of death leading to extreme inflammatory regional hospitals combined during the from their underlying disease than from changes that caused severe disease and same period. COVID-19 and needed treatment. death. These findings were published in Journal of Hepatology rapidly, and the We quickly surveyed programs across In collaboration with MedStar Georgetown’s Institute now is working towards infectious disease team and coordinated the nation, took best practices, and a clinical trial with a new substance efforts across the MedStar Health System, enacted an aggressive strategy to for treatment. create COVID-free transplant floors and the Institute took early and aggressive ICU units and implement the highest Since the beginning of this pandemic, measures to implement the highest safety safety protocols to safeguard the as our world has turned upside down, protocols to safeguard the health of health of recipients and living donors. I have been so profoundly impressed transplant recipients and living donors. Working with hospital administration, to witness the teamwork, collaboration, infection control, infectious diseases, ingenuity, selflessness, and dedication “Patients with organ failure are among the and other colleagues, we overhauled of the MedStar Georgetown most vulnerable populations, and life- all our workflows, instituting telehealth, Transplant Institute staff, both clinical saving transplants are critical. While caring breaking up clinical teams, and creating and administrative. Through their for patients with COVID-19 was an urgent the transplant only inpatient units. tireless and unselfish dedication to mission, we could not abandon equally the patients we have the privilege We also recognized the need for of caring for, we managed to safely critical transplant patients. We surveyed best data to guide how we approach our provide more kidney transplants than practices across the nation and developed a patients who contracted COVID-19 any program in the country and remain systematic approach that was individualized though community transmission. one of the most active transplant for us. Working quickly and involving Working through both MedStar programs. I am truly fortunate to work everyone from the top of the organization Health and Georgetown University, with an incredible team that treats down led to our success,” Executive Director we refocused all our research on the all our patients with such dignity in of MedStar Georgetown Transplant Institute, inflammatory pathways that were extraordinarily difficult times. Dr. Thomas Fishbein, said. being activated through COVID-19 among transplant, liver disease, and kidney disease patients. The enhanced safety and infection prevention protocol included: We identified critical changes in Thomas M. Fishbein, MD inflammatory pathways upregulated Executive Director • Priority COVID-19 testing for transplant among these patients, which led to the MedStar Georgetown recipients to rule out recipients who had high risk of severe disease. Increased Transplant Institute the virus before they were transplanted continued on page 12 2 TO REFER A PATIENT, CALL 202-444-3700. TRANSPLANTdigest FALL 2020 Paired Kidney Exchange Markedly Increases Number of Transplants When a patient in need of a kidney them to the top of the waiting list when transplant is not compatible with his they need a transplant. In addition, or her living donor, a paired kidney through the Family Voucher Program, exchange (PKE) can not only help if a donor is interested in donating a that initial patient get the needed kidney without having an intended transplant, it can also facilitate recipient but has a realistic concern that transplants for other recipients who a family member may need a kidney also do not have a compatible donor. transplant in the future, they are able to MedStar Georgetown Transplant designate up to five first-degree family Institute is a national leader in PKE. members who will receive vouchers In 2019, of the 115 living kidney that allow them to go to the top of the donor transplants performed at the waiting list if they ever need a kidney Institute, 57 were the result of the transplant. Institute’s participation in the National Kidney Registry’s (NKR) paired kidney Breaking down barriers exchange program. to donation Through the Institute’s partnership “Thirty-three percent of individual associated with any complications with the NKR, patients in need of a donor and recipient pairs that that result from donation, legal kidney also get help broadening their present to a transplant program representation should a donor’s search for a donor online. Through have incompatible blood types or a employment or health insurance be the program, patients searching for a positive cross match. This means they negatively affected by living donation, living kidney donor can set up a free can’t donate directly to their intended and prioritization for living donor microsite (webpage). The site gives recipient,” explains Matthew Cooper, transplant in the unlikely case that a them the chance to share their story MD, director of Kidney and Pancreas donor’s remaining kidney fails. Donors through social media with a wider Transplantation. “Fifteen years ago, we may also qualify for lost wage and travel audience, which can help them find a unfortunately told patients they had to and lodging
Load more

Recommended publications
  • How Long Will I Have to Wait for a New Kidney?
    Frequently Asked Questions For Waitlisted Patients Questions About My Follow-up On the Waitlist Q: How long will I have to wait for a new kidney? Wait time for a donor organ is dependent upon several factors. These include your blood type, tissue matching, presence of preformed antibodies, and the time from which you began dialysis. o Expected patient waiting times will vary depending upon your geographical location within the United States as well as the local Organ Procurement Organization (OPO). o The following lists of websites can be used a source for information regarding the organ transplant wait list, waiting times, and organ donation. www.unos.org . http://optn.transplant.hrsa.gov . www.transplantliving.org Average wait times in the D.C., Maryland, and Virginia region are as follows: o Blood Group A: 3 years (1095-1190 days) o Blood Group B: 5-6 years (1838-2125 days) o Blood Group O: 5 years (1778-1891 days) o Blood Group AB: 2 years (578-866 days) As of December 4, 2014, your wait time will be calculated from the day you started dialysis (not the date you completed your evaluation) o For patients listed before they started dialysis, your time will still calculate from your date of listing. Q: How often should I expect to be in touch with the transplant center? We typically like to see patients once a year while on the waitlist so that we can keep updated on medical issues that might affect getting a transplant For patients with more significant medical history, we may see you as frequently as every 6 months While we may only be in touch with you every 6-12 months, you should always feel free to contact us at 202-444-3700.
    [Show full text]
  • Editorial the National Kidney Registry
    Editorial The National Kidney Registry Time to Buy In? Bushra Syed and Joshua J. Augustine CJASN 15: 168–170, 2020. doi: https://doi.org/10.2215/CJN.14581119 In this issue of CJASN, Leeser et al. (1) describe patient as measured by panel reactive antibody (PRA). Despite Department of and graft survival in patients who participated in the these risk factors, the National Kidney Registry recip- Nephrology and National Kidney Registry, a nonprofit, 501(c) organi- ients displayed superior death-censored graft survival. Hypertension, Cleveland Clinic, zation founded in 2007 to facilitate living kidney donor It is unclear what may have led to improved outcomes Cleveland, Ohio exchange. Outcomes of recipients of paired kidneys in in the National Kidney Registry recipients. Recipients n5 the National Kidney Registry ( 2363) were compared who participated in the National Kidney Registry may Correspondence: with outcomes in all living donor recipients from have been carefully selected with favorable resources, Dr. Joshua J. registry data (n554,497), control unrelated living do- education, and adherence. National Kidney Registry Augustine, nor recipients (n525,900), and control patients who recipients may also have had lower rates of donor- Department of fi Nephrology and received kidneys through non-National Kidney Regis- speci c antibodies or need for desensitization, although Hypertension, try paired donation (n54535). Because of shipping of such data were not available for the non-National Cleveland Clinic most kidneys, National Kidney Registry transplants had Kidney Registry cohort. Rates of desensitization in the Lerner College of a notably greater cold ischemic time (9 hours versus National Kidney Registry have dropped to ,5% since Medicine, 9500 1 hour for the primary control group).
    [Show full text]
  • The National Kidney Registry: Time to Buy
    CJASN ePress. Published on January 28, 2020 as doi: 10.2215/CJN.14581119 Editorial The National Kidney Registry Time to Buy In? Bushra Syed and Joshua J. Augustine CJASN 15: ccc–ccc, 2020. doi: https://doi.org/10.2215/CJN.14581119 In this issue of CJASN, Leeser et al. (1) describe patient as measured by panel reactive antibody (PRA). Despite Department of and graft survival in patients who participated in the these risk factors, the National Kidney Registry recip- Nephrology and National Kidney Registry, a nonprofit, 501(c) organi- ients displayed superior death-censored graft survival. Hypertension, Cleveland Clinic, zation founded in 2007 to facilitate living kidney donor It is unclear what may have led to improved outcomes Cleveland, Ohio exchange. Outcomes of recipients of paired kidneys in in the National Kidney Registry recipients. Recipients n5 the National Kidney Registry ( 2363) were compared who participated in the National Kidney Registry may Correspondence: with outcomes in all living donor recipients from have been carefully selected with favorable resources, Dr. Joshua J. registry data (n554,497), control unrelated living do- education, and adherence. National Kidney Registry Augustine, nor recipients (n525,900), and control patients who recipients may also have had lower rates of donor- Department of fi Nephrology and received kidneys through non-National Kidney Regis- speci c antibodies or need for desensitization, although Hypertension, try paired donation (n54535). Because of shipping of such data were not available for the non-National Cleveland Clinic most kidneys, National Kidney Registry transplants had Kidney Registry cohort. Rates of desensitization in the Lerner College of a notably greater cold ischemic time (9 hours versus National Kidney Registry have dropped to ,5% since Medicine, 9500 1 hour for the primary control group).
    [Show full text]
  • Paired Kidney Exchange Transplantation – Pushing the Boundaries
    Transplant International REVIEW Paired kidney exchange transplantation – pushing the boundaries Vijay Kher & Pranaw Kumar Jha Department of Nephrology & SUMMARY Transplant Medicine, Medanta – The The scarcity of living organ donors makes it imperative to develop newer Medicity, Gurgaon, Harayana, India innovations to optimize and maximize the utilization of the available pool. ABO and HLA sensitization are important immunological barriers in renal Correspondence Vijay Kher, Medanta Kidney and transplant and can potentially lead to rejection of almost one-third of the Urology Institute, Division of willing living donors. Paired kidney exchange (PKE) is a rapidly growing Nephrology and Kidney Transplant method used to overcome these barriers and has grown in popularity over Medicine Medanta, The Medicity the last three decades since its introduction in 1986. Evolution of the Gurugram, Haryana, India. matching strategies and use of complex algorithms has led to increase in Tel.: 91-1244141414; the number of possible matches thereby benefiting multiple recipients. The fax: 911-244834111; use of altruistic donors and compatible pairs has also helped in increasing e-mails: [email protected]; the possible exchanges. This review provides an in-depth analysis of the [email protected] evolution, the present global scenario, and the future of PKE. It also dis- cusses the recent trends of advanced donation, trans-organ paired exchange and global kidney exchange and the associated ethical concerns. Transplant International 2020; 33: 975–984 Key words domino kidney paired donation, kidney paired donation, paired kidney exchange, renal transplant Received: 24 June 2019; Revision requested: 2 August 2019; Accepted: 1 July 2020; Published online: 2 August 2020 recipient–donor pair is said to be compatible if their Introduction blood groups match and the crossmatch is negative.
    [Show full text]
  • Kidney and Pancreas Transplant Program Information for Potential Kidney Donors: What You Need to Know About Becoming a Kidney Donor
    Kidney and Pancreas Transplant Program Information for Potential Kidney Donors: What You Need to Know about Becoming a Kidney Donor You have the power to Donate LifeSM INNOVATIVE AND HIGHLY Our Living Donor Program EXPERIENCED LIVING DONOR TEAM This booklet is designed to introduce you to the basic concepts of kidney donation. If you are thinking about being a donor for someone who needs a kidney transplant, we hope that you will find the booklet to be a useful resource. At NewYork-Presbyterian/Weill Cornell Transplant Center, we have the largest Living Donor Kidney Program on the east coast and third largest in the United States, along We have the with one of the top Kidney Paired Donation longest history of Programs (p.4). Although our focus is providing kidney kidney transplants to patients in need, our living transplantation in donor program is designed to first protect you, the New York, potential kidney donor. We have separate medical performing New teams for the donor and the recipient. You will be assigned an independent living donor team to help York’s first Kidney you through the evaluation and donation process, transplant in 1963. and always look out for your best interests. Photo: Parents Brian and Evette each donated a kidney to twin sons Alan and Brian. Who Can Be a Donor? The majority of kidney donors have an established relationship with the person needing a kidney: a relative, spouse, friend, co-worker, or neighbor. However, there are also people who wish to donate a kidney to someone, but do not have a specific recipient in mind.
    [Show full text]
  • Early Graft Losses in Paired Kidney Exchange: Experience from 10 Years of the National Kidney Registry
    Received: 2 October 2019 | Revised: 3 December 2019 | Accepted: 30 December 2019 DOI: 10.1111/ajt.15778 BRIEF COMMUNICATION Early graft losses in paired kidney exchange: Experience from 10 years of the National Kidney Registry Jennifer Verbesey1 | Alvin G. Thomas2,3 | Matt Ronin4 | Jennifer Beaumont5 | Amy Waterman5,6 | Dorry L. Segev3,7,8 | Stuart M. Flechner9 | Matthew Cooper1 1Medstar Georgetown Transplant Institute, Washington, District of Columbia Cooperative kidney paired donation (KPD) networks account for an increasing pro- 2Department of Epidemiology, University of portion of all living donor kidney transplants in the United States. There are sparse North Carolina, Chapel Hill, North Carolina data on the rate of primary nonfunction (PNF) losses and their consequences within 3Department of Surgery, Johns Hopkins KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, University School of Medicine, Baltimore, Maryland 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of trans- 4 National Kidney Registry, Babylon, New plantation, and graft losses in the first-year posttransplant and assessed potential risk York factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 5Terasaki Research Institute, Los Angeles, California (0.5%) with PNF. When compared to functioning grafts, there were no clinically sig- 6Department of Nephrology, University of nificant differences in blood type compatibility, degree of HLA mismatch, number of California, Los Angeles, California veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early 7Department of Epidemiology, Johns Hopkins School of Public Health, venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and Minneapolis, Minnesota development of antibody-mediated rejection (AMR).
    [Show full text]
  • Inferior Long- Term Allograft and Patient Outcomes Among Recipients of Offspring Living Donor Kidneys
    Received: 11 August 2017 | Revised: 7 December 2017 | Accepted: 12 December 2017 DOI: 10.1111/ajt.14631 ORIGINAL ARTICLE Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys J. B. Cohen1,2 | L. Owei2 | D. L. Sawinski1,2 | P. M. Porrett2,3 1Renal-Electrolyte and Hypertension Division, Department of Medicine, University While offspring- to- parent living donor kidney transplantations may represent an ideal of Pennsylvania, Philadelphia, PA, USA donor–recipient combination to optimize long- term transplantation outcomes, the 2 Perelman School of Medicine, University of sex- specific long- term success of these transplantations remains unclear. We hypoth- Pennsylvania, Philadelphia, PA, USA esize that allograft and recipient survivals in offspring- to- parent living donor kidney 3Division of Transplant Surgery, Department of Surgery, Hospital of the University of transplantation differ between men and women due to donor- specific alloimmuniza- Pennsylvania, Philadelphia, PA, USA tion during pregnancy. We retrospectively analyzed long- term allograft and patient Correspondence survival among men and women who received an offspring living donor kidney com- Jordana B. Cohen pared with those who received other haplotype- matched living donor kidneys. Based Email: [email protected] on multivariable Cox proportional hazards modeling of Organ Procurement and Funding information Transplantation Network data from 2001 to 2015, we found that both men and National Heart, Lung, and Blood Institute,
    [Show full text]
  • Asynchronous, Out-Of-Sequence, Transcontinental Chain Kidney Transplantation: a Novel Concept
    American Journal of Transplantation 2009; 9: 2180–2185 C 2009 The Authors Wiley Periodicals Inc. Journal compilation C 2009 The American Society of Transplantation and the American Society of Transplant Surgeons Brief Communication doi: 10.1111/j.1600-6143.2009.02730.x Asynchronous, Out-of-Sequence, Transcontinental Chain Kidney Transplantation: A Novel Concept F. K. Butta,H.A.Gritschb,P.Schulamb, Received 17 January 2009, revised 12 April 2009 and G. M. Danovitchc, A. Wilkinsonc,J.DelPizzod, accepted for publication 29 April 2009 S. Kapure,D.Serurf, S. Katznelsong, S. Busqueh, M. L. Melcherh,S.McGuirei, M. Charltonj,G.Hilk and J. L. Vealeb,* Introduction aDepartment of Surgery, bDepartment of Urology and According to the United Network for Organ Sharing cDepartment of Medicine, UCLA, Los Angeles, CA (UNOS), over 70 000 people are currently listed, awaiting dDepartment of Urology, eDepartment of Surgery and kidney transplantation nationwide, but only 13 148 living fDepartment of Medicine, NYP/Cornell, New York, NY and deceased kidney donors were available in 2008 (1). gDepartment of Medicine, California Pacific Medical One possible solution is to develop a national living donor Center, San Francisco, CA kidney exchange program (2–5). Patients with willing, in- h Department of Surgery, Stanford University Medical compatible living donors would receive a compatible kid- Center, Palo Alto, CA ney through a ’donor exchange‘ with another incompatible iDepartment of Kidney Transplant Services, UCLA, Los Angeles, CA pair. Successful programs utilizing paired exchanges exist jDepartment of Kidney Transplant Services, NYP/Cornell, in the Netherlands (2) and Korea (5,6). An estimated addi- New York, NY tional 2000 kidney transplants could be performed annually kFounder of the National Kidney Registry if a similar program were implemented in the United States *Corresponding author: Jeffrey L.Veale, (7,8).
    [Show full text]
  • Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted
    Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Anderson, Ross et al. “Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted.” Interfaces 45, 1 (February 2015): 26–42 © 2015 Institute for Operations Research and the Management Sciences (INFORMS) As Published http://dx.doi.org/10.1287/inte.2014.0766 Publisher Institute for Operations Research and the Management Sciences (INFORMS) Version Author's final manuscript Citable link http://hdl.handle.net/1721.1/111107 Terms of Use Creative Commons Attribution-Noncommercial-Share Alike Detailed Terms http://creativecommons.org/licenses/by-nc-sa/4.0/ Kidney Exchange and the Alliance for Paired Donation Ross Anderson, Itai Ashlagi, David Gamarnik, Michael Rees, Alvin E. Roth, Tayfun Sönmez and M. Utku Ünver1 Abstract Many end-stage renal disease sufferers who require a kidney transplant to prolong their lives have relatives or associates who have volunteered to donate a kidney to them, but whose kidney is incompatible with their intended recipient. This incompatibility can be sometimes overcome by exchanging kidneys with another incompatible donor pair. Such kidney exchanges have emerged as a standard mode of kidney transplantation in the United States. The Alliance for Paired Donation (APD) developed and implemented an innovative operations research based methodology of non-simultaneous extended altruistic donor (NEAD) chains, which, by allowing a previously binding constraint (of simultaneity) to be relaxed, allowed better optimized matching of potential donors to patients, which greatly increases the number of possible transplants.
    [Show full text]
  • The Positive Effect of Altruistic Kidney Paired Donor Chains
    SAVING LIVES THROUGH INCREASING AVAILABLE DONOR KIDNEYS: THE POSITIVE EFFECT OF ALTRUISTIC KIDNEY PAIRED DONOR CHAINS A Thesis submitted to the Faculty of The School of Continuing Studies and of The Graduate School of Arts and Sciences in partial fulfillment of the requirements for the degree of Master of Arts in Liberal Studies By Nikita Denise Harmon, B.A. Georgetown University Washington, D.C. April 1, 2013 Copyright 20123 by Nikita Denise Harmon All Rights Reserved ii SAVING LIVES THROUGH INCREASING AVAILABLE DONOR KIDNEYS: THE POSITIVE EFFECT OF ALTRUISTIC KIDNEY PAIRED DONOR CHAINS. Nikita Denise Harmon, B.A. MALS Mentor: Gladys White, Ph.D. ABSTRACT This thesis will propose that altruistic kidney paired donor chains will save more lives of end-stage renal disease (ESRD) patients by increasing the number of available donor kidneys for kidney transplantation in the United States. Altruistic kidney paired donor chains make the most of a living, healthy and willing potential kidney donor who is immunologically incompatible to his or her directed end-stage renal disease patient. These donor chains enable the potential immunologically incompatible living kidney donor to donate to another ESRD patient, who is immunologically compatible, while their directed patient can receive a kidney from another living donor that is immunologically compatible. This thesis will explain in detail the importance of the kidneys via their physical functions in order to sustain life. It will elaborate on the fact that an ESRD patient is limited to two therapeutic choices in order to live. Kidney transplantation is deemed the ideal therapeutic option for providing standard renal functions for ESRD patients.
    [Show full text]
  • Center-Defined Unacceptable HLA Antigens Facilitate Transplants For
    American Journal of Transplantation 2014; XX: 1–7 C Copyright 2014 The American Society of Transplantation Wiley Periodicals Inc. and the American Society of Transplant Surgeons doi: 10.1111/ajt.12734 Center-Defined Unacceptable HLA Antigens Facilitate Transplants for Sensitized Patients in a Multi-Center Kidney Exchange Program L. A. Baxter-Lowe1, M. Cecka2, M. Kamoun3, Abbreviations: CPRA, calculated panel reactive anti- J. Sinacore4 and M. L. Melcher5 body; DSA, donor-specific antibody; KPD, kidney paired donation; MFI, mean fluorescence intensity; 1 NKR, National Kidney Registry; OPTN, Organ Procure- HLA Laboratory, Children’s Hospital Los Angeles, Los ment and Transplantation Network Angeles, CA 2 UCLA Immunogenetics Center, University of California Received 21 October 2013, revised 21 February 2014 Los Angeles, Los Angeles, CA and accepted for publication 26 February 2014 3Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 4National Kidney Registry, Babylon, NY 5Department of Surgery, Stanford University, Stanford, CA Introduction ÃCorresponding author: Lee Ann Baxter-Lowe, [email protected] Kidney paired donation (KPD) offers new transplant opportunities for patients with a living donor who is willing and medically suitable but HLA or ABO incompatible (1). The usefulness of KPD has been demonstrated by large Multi-center kidney paired donation (KPD) is an single-center KPD programs that have used this approach exciting new transplant option that has not yet for up to 35% of their living donor transplants (2–4). approached its full potential. One barrier to progress Theoretically, multi-center KPD programs with larger pools is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients.
    [Show full text]
  • NKR KPD Coordinator's Training Forum
    Future Directions in Paired Exchange Paired Exchange Summit and Coordinator Training Forum Thursday, June 28th and Friday, June 29th 2018 The Sheraton Times Square Hotel – New York City The Sheraton Times Square Hotel New York City Join us at the 10th Annual “Season of Miracles Awards Gala” The Rainbow Room 30 Rockefeller Plaza June 28, 2018 – 5:30-10:00pm To register go to—> www.kidneyregistry.org/RSVP Paired Exchange Summit Friday, June 29th 2018 Time Time Topic Speaker Allotments 10:00 am Welcome & Opening Comments Sandi Kapur 5 minutes Call to Order & Report to 10:05 am Garet Hil 5 minutes Medical Board Reports from Committee Chairs 10:10 am Operations Suzanne McGuire 5 minutes Please join the NKR Medical Board as we tackle the most pressing issues facing 10:15 am Admin/Finance TBD 5 minutes Paired Kidney Exchange. This is an open forum, where you’ll have 10:20 am Nephology David Serur 5 minutes an opportunity to sit in on a Medical Board meeting and voice your own opinions to 10:25 am Histo/Lab Mike Cecka 5 minutes help shape the discussion on the critical topics being deliberated by the NKR 10:30 am Research Amy Waterman 5 minutes Medical Board. These events are free of charge for up to two attendees from each 10:35 am Surgical Matt Cooper 5 minutes NKR member center. 10:40 am Q & A 10 minutes Voucher Program – 10:50 am 15 minutes Challenges & Opportunities Jeff Veale 11:05 am Open/discussion All 10 minutes Surgical Unavailability – 11:15 am Matt Cooper 15 minutes Biggest Obstacle of KPD 11:30 am Open/discussion All 10 minutes 11:40
    [Show full text]