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OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies

OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies. Kidney Transplantation Committee Richard Formica, MD (Chair). Strategic Plan. The Problem. Relatively low match success rate in OPTN KPD program

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OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies

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  1. OPTN Kidney Paired Donation (KPD) Histocompatibility Testing Policies Kidney Transplantation Committee Richard Formica, MD (Chair)

  2. StrategicPlan

  3. The Problem • Relatively low match success rate in OPTN KPD program • Antibody related issues and positive crossmatches continue to account for a significant number of match failures • Insufficient histocompatibility testing requirements to prevent match failure

  4. Proposed: HLA Typing • Full list of HLA types must be reported on KPD donors • List of HLA types required for all candidates consistent with those for DD kidney policy • If candidate has unacceptable antigens, the corresponding HLA type must be reported • Molecular HLA typing required for candidates • Candidate’s hospital must retype donor to confirm HLA type

  5. Proposed: Antibody Screenings • Candidate’s transplant hospital must screen all KPD candidates for antibodies: • every 90 days (+/- 20 days) • when potentially sensitizing event occurs • if candidate reactivated after more than 90 inactive days • if unacceptable positive crossmatch occurs that prevents transplant with matched donor • Physician/surgeon (or designee) and lab director (or designee) must review UAs listed for candidate before their first match run.

  6. Proposed: Crossmatching Candidate’s transplant hospital must: • perform physical crossmatch before donor’s nephrectomy is scheduled and final crossmatch prior to transplant • report crossmatch results to donor’s transplant hospital and UNOS • report a reason for unacceptable positive crossmatch within 7 days If unacceptable positive crossmatch occurs that breaks the chain, UNOS will make candidate ineligible before next match run. Candidate will be eligible once candidate’s program reports that a review of UAs is complete.

  7. Overview of public comments

  8. What Members Will Need to Do

  9. Overall Project Impact 1,650/10,680 2290/17,885

  10. Cost v. Benefit

  11. Resolution 21 (page 79) RESOLVED, that additions and modifications to Policies 13: (Kidney Paired Donation (KPD)); 13.5 (Histocompatibility Testing); 13.6 (Matching within the OPTN KPD Program); 13.7 (KPD Screening Criteria); and 13.10 (Crossmatching Protocol), as set forth on page 79, are hereby approved, effective pending programming and notice to the OPTN membership.

  12. Extras

  13. Background

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