1. Rethinking incompatibility in kidney transplantation
- Author
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Kyle R. Jackson and Dorry L. Segev
- Subjects
Transplantation ,medicine.medical_specialty ,Tissue and Organ Procurement ,Kidney Paired Donation ,business.industry ,Human leukocyte antigen ,medicine.disease ,Kidney Transplantation ,Living donor ,Donor Selection ,Clinical decision making ,HLA Antigens ,ABO blood group system ,Living Donors ,medicine ,Humans ,Kidney Failure, Chronic ,Immunology and Allergy ,Pharmacology (medical) ,Graft survival ,Intensive care medicine ,business ,Kidney transplantation - Abstract
Donor/recipient incompatibility in kidney transplantation classically refers to ABO/HLA-incompatibility. Kidney paired donation (KPD) was historically established to circumvent ABO/HLA-incompatibility, with the goal of identifying ABO/HLA-compatible matches. However, there is a broad range of donor factors known to impact recipient outcomes beyond ABO/HLA-incompatibility, such as age and weight, and quantitative tools are now available to empirically compare potential living donors across many of these factors, such as the living donor kidney donor profile index (LKDPI). Moreover, the detrimental impact of mismatch at other HLA antigens (such as DQ) and epitope mismatching on post-transplant outcomes has become increasingly recognized. Thus, it is time for a new paradigm of incompatibility that considers all of these risks factors together in assessing donor/recipient compatibility and the potential utility for KPD. Under this new paradigm of incompatibility, we show how the LKDPI and other tools can be used to identify donor/recipient incompatibilities that could be improved through KPD, even for those with a traditionally 'compatible' living donor.
- Published
- 2022