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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. A cohort of seven pediatric renal transplants performed through the Australian Kidney Exchange (AKX) is outlined including barriers to alternative transplant and outcomes after KPD. Reasons for entering KPD were pre-formed donor specific antibodies (DSA) 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 to registered donor. All grafts are functioning, mean eGFR 77 ml/min/1.73m2 (range 46-94ml), with a follow up range 8-54 months and no patient has experienced any episodes of 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 minimise immunological risks. |
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