Paired Kidney Exchange Update
October 13, 2012
Karen M. Miller
National Kidney Registry
Why Does it Work?
•
•
•
•
Over 60 centers have joined
538 transplants to date
308 active donors in the pool
Match runs completed daily
Simultaneous
Domino Paired Donation
(DPD)
Nonsimultaneous Extended
Altruistic Donor Chains
(NEAD)
NEAD
NDD
R
Cluster #1
D
R
D
R
D
R
D
R
D
BD
R
R
D
D
R
R
BD
R
Cluster #2
D
WL
Cluster #3
.
R
D
Etc.
Children and High PRA (CHIPS)
• Children--No living donor
• Adult--WL > 3 years, Highly sensitized,
past donor, on dialysis
• ABO = A, B, AB with greatest chance
• Max 50 patients
Match Offer Process
Daily
Match
Runs
Match
Match
Acceptance
Emailed
Match
Offers
Emailed
1 - 2 Days
Test
Transplant
Cross
Matches
Completed
Cross
Matches
Initiated
10 Days
Surgery
Date/Time
Set
Surgeries
Performed
2-5 Weeks
Pair Match Power
• Pair Match Power is the key to
understanding wait time
•
Pair Match Power (PMP) is the most
accurate predictor of paired exchange wait
time and should be used by patients and
clinicians to develop individual matching
strategies for pairs
How is PMP Calculated?
Rule of Thumb
•
•
•
•
If PMP=400+
If PMP>200
If PMP<100
If PMP=0
Pair will match immediately
Pair is easy to match
Pair is hard to match
Pair nearly impossible to match
Match Acceptance Deadline: 9/10/12 15:00
Pos
D Ctr
Donor
Alias
R Ctr
Recipi
ent
Alias
D-ABO
R-ABO
D-Age
R-Age
Recp
Avoids
PMP
CPRA
Wait
Time
Match
Points
1
PorterAH
DBURN0
04
Brigham
PA020
666
O
O
23
45
16
532
72
0
60
Yes
n/s
2
Brigham
JI060776
UCLA
R4737
O
O
35
58
3
26
59
0
25
Yes
n/s
3
UCLA
D4237
Jefferson
CARO
S
A
A
36
43
43
28
99
16
25
Yes
n/s
4
Jefferson
DIOGS
UCSF
RE758
B
O
O
44
39
0
175
0
2
0
Yes
n/s
5
UCSF
DG759S
Madison
MCKE
W
O
O
60
58
13
65
94
12
25
Yes
n/s
6
Madison
UNDEJ
VAHD
BKH03
38
O
O
57
55
0
61
0
8
60
Yes
n/s
7
VAHD
SUR20
50
A
A
56
28
26
26
97
25
80
Yes
n/s
Stanford SUD2052 Madison STRAR
O
O
23
35
6
56
85
5
45
Yes
n/s
8
9
Madison
JGH8979 Stanford
LIPPP
O
53
Preselec Target
t
Surgery
Status
Date
UW Update
•
•
•
•
•
•
Joined NKR 12/2010
1st paired exchange 2/2011
17 transplants in 2011
14 transplants in 2012 (as of 9/24/12)
4 non directed donors in 2012 (9 in 2011)
5 highly sensitized patients transplanted
with no desensitization PRA > 85%
•
•
•
•
18 pairs active
45 CHIP active
6 active chains
Two chains with three pairs scheduled
In Summary
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•
•
•
•
Paired Kidney Exchange works
Gives hope to highly sensitized patients
Able to use good and willing donors
Able to better inform patients r/t PMP
Many highs and lows