MP30-10: Global Kidney Exchange: Striving for Trifecta Outcomes in management of Kidney Failure Presentation (Faculty180)

cited authors

  • Ekwenna, Obi


  • Introduction: While organ shortage is the major limitation to kidney transplantation in the developed world, in resource poor countries, financial barriers prevent kidney transplantation much more often—even when willing living kidney donors are available. Global Kidney Exchange (GKE) is a unique approach that allows mutual benefit between patients-donor pairs in rich and poor nations who face barriers to transplantation. Methods: We propose that the cost difference between dialysis and transplantation in some countries would allow the exchange of kidneys between developed world patient/donor pairs with immunological barriers and developing-world patient/donor pairs with financial barriers to transplantation. Results: Through the GKE 3 BT-O donors (2 from the Philippines and 1 from Mexico) were identified. Three Non-simultaneous extended altruistic donors (NEAD) chain were identified with each US BT-A non-directed donor (NDD) with no match in a regional kidney paired donation (KPD) pool. A US NDD or bridge donor donated to a foreign recipient creating a chain of kidney transplants. So far a total of 27 kidney transplants have been generated, with each chain producing 12, 9 and 6 transplants respectively. The blood type of the 27 GKE recipients were BT-0 in 14, BT-A in 9, and BT-B in 4. Of the 27 GKE recipients, 10 had a PRA of 0-20%, 11 had a PRA of 21-79%, and 6 had a PRA of >80%. Two of the chains remain open at this time with bridge donors awaiting donation, with the potential to extend the number of total transplants. The transplant cost for each foreign recipient was paid for by Philanthropy. An additional, $50,000 was reserved for subsequent immunosuppression for follow-up of the foreign donor/recipient pair. The cost saving from transplanting 24 U.S patients compared with the cost of dialysis will exceed $7.3 million over a 5 year period. At most recent follow-up all patients have excellent renal function. Conclusions: GKE is an innovative approach that achieves the trifecta (cost reduction, quality of life improvement, and assess to kidney transplant) in the management of all patients with End-stage renal disease by providing increased opportunities for transplantation for all blood types and levels of sensitization Source Of Funding: Alliance for Paired Donation Rejuvenate HealthCare, Inc


publication date

  • 2017

presented at event