Paired Kidney Exchange Update

October 13, 2012Karen M. Miller

National Kidney RegistryWhy Does it Work?

• Over 60 centers have joined • 538 transplants to date • 308 active donors in the pool• Match runs completed daily

NEAD

D R

DR

BD R

DR

D

Cluster #1

Cluster #2

R

R

R

D

BD

Etc.

Cluster #3

NDD

D R

DR

R

.

Simultaneous Domino Paired Donation

(DPD)

D R

D

WL

Nonsimultaneous Extended Altruistic Donor Chains (NEAD)

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 Offers

Emailed

Match Acceptance

Emailed

Cross Matches Initiated

Cross Matches

Completed

Surgery Date/Time

Set

Surgeries Performed

1 - 2 Days 10 Days 2-5 Weeks

Match Test Transplant

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+ Pair will match immediately

• If PMP>200 Pair is easy to match• If PMP<100 Pair is hard to match• If PMP=0 Pair nearly impossible to

match

Pos D CtrDonorAlias

R CtrRecipi

entAlias

D-ABO R-ABO D-Age R-AgeRecp

AvoidsPMP CPRA

WaitTime

MatchPoints

PreselectStatus

TargetSurgery

Date

1 PorterAHDBURN0

04Brigham

PA020666

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 JeffersonCARO

SA A 36 43 43 28 99 16 25 Yes n/s

4 Jefferson DIOGS UCSFRE758

BO O 44 39 0 175 0 2 0 Yes n/s

5 UCSF DG759S MadisonMCKE

WO O 60 58 13 65 94 12 25 Yes n/s

6 Madison UNDEJ VAHDBKH03

38O O 57 55 0 61 0 8 60 Yes n/s

7 VAHD JGH8979 StanfordSUR20

50A A 56 28 26 26 97 25 80 Yes n/s

8 Stanford SUD2052 Madison STRAR O O 23 35 6 56 85 5 45 Yes n/s

9 Madison LIPPP     O   53                

Match Acceptance Deadline: 9/10/12 15:00

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

• 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