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Desensitization in the Era of Kidney Paired Donation

Desensitization in the Era of Kidney Paired Donation. Mark D. Stegall, M.D. Institution : Mayo Clinic, Rochester. Research contracts with Alexion and Millenium My presentation includes discussion of off-label and investigational. Yes—Eculizumab, Alexion Pharmaceuticals;. Disclosure.

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Desensitization in the Era of Kidney Paired Donation

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  1. Desensitization in the Era of Kidney Paired Donation Mark D. Stegall, M.D.

  2. Institution : Mayo Clinic, Rochester. Research contracts with Alexion and Millenium My presentation includes discussion of off-label and investigational. Yes—Eculizumab, Alexion Pharmaceuticals; Disclosure.

  3. The Limits of Paired Donation: Who Doesn’t Get Transplanted?

  4. Deceased Donor List

  5. 9000 cPRA>95%

  6. Transplant Rates by cPRA 4400/6 mos

  7. Actual Death-Censored5 Year Graft Survival 70.7% vs 88.0%, p= 0.0006

  8. Paired Donation

  9. National Kidney Registry 63% cPRA>95%

  10. Mayo Foundation 3-Site KPD Program • Cooperative: virtually one cost center and one protocol • Screen multiple donors (HLA type) and do full workup when a chain emerges

  11. Two Eras • Phase I: Avoid desensitization • Accept +XM up to channel shift of 200 (3000 MFI or so) • 8/2009-12/2012 (90 KPDs) • Phase II: Allow desensitization • 3 months is KPD • If no chain, then allow +XMKTx with desentization • 1/2013--present

  12. Figure 1 Time (Days) cPRA

  13. cPRA by MFI

  14. Phase IIKPD + Desensitization Recipients with cPRA >90 who received a Transplant in Phase 2

  15. Phase IIKPD + Desensitization 10 cPRA >95% transplanted

  16. Phase IIKPD + Desensitization 10 cPRA >95% transplanted 4 KPD 2 no desensitization 2 desensitization (lower +XM)

  17. Phase IIKPD + Desensitization 10 cPRA >95% transplanted 4 KPD 2 no desensitization 2 desensitization (lower +XM) 4 original donor

  18. Phase IIKPD + Desensitization 10 cPRA >95% transplanted 4 KPD 2 no desensitization 2 desensitization (lower +XM) 4 original donor 2 deceased donors

  19. Conclusions • Sensitized patients have more transplant options than before

  20. Conclusions • Sensitized patients have more transplant options than before • Donor without antibody is ideal—paired donation/deceased donation

  21. Conclusions • Sensitized patients have more transplant options than before • Donor without antibody is ideal—paired donation/deceased donation • Donor with lowest level of antibody is the next best option

  22. Conclusions • Sensitized patients have more transplant options than before • Donor without antibody is ideal—paired donation/deceased donation • Donor with lowest level of antibody is the next best option • +Crossmatch Kidney Transplant may be the only viable option

  23. Conclusions • Sensitized patients have more transplant options than before • Donor without antibody is ideal—paired donation/deceased donation • Donor with lowest level of antibody is the next best option • +Crossmatch Kidney Transplant may be the only viable option • New therapies are needed to control antibody and its effects on the kidney transplant

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