Page 20 - Layout 1
P. 20
TRANSPLANTS
& TRANSFUSION
turning No
into yes
at the Nation’s Largest Living Donor Hospital
Francis H. Wright, MD, FACS
Methodist Healthcare System Organ Transplant Programs
”doctor, i have a kidney donor!” ... “i’m sorry, your ABO or DSA incompatibilities are not always just yes-no situations
donor is not a match.” and some level of incompatibility may be safely manageable and
allow a transplant to proceed. Newer laboratory methods for detec-
So begins another five or six year wait for a kidney transplant, tion and classification of antibodies are essential for managing living
along with more than 100,000 others in the United States. However, donation and KPD transplantation. A computer matching system is
this also began the Kidney Paired Donation (KPD) program at also needed for the several hundred persons that are in the MSTH
Methodist Specialty and Transplant Hospital (MSTH) which has be- KPD database awaiting a match. The matching process can be quite
come the largest KPD experience of any hospital world-wide. It has complex with multiple blood types and hundreds of antibody com-
helped the MSTH live donor kidney program to grow to the busiest binations.
in the U.S. since 2009, performing over 1,150 live donors and facil-
itating over 330 KPD transplants. “how would an exchange work, doctor?”
The simplest KPD exchange occurs when two donor-recipient
“Why am i not a match?”
There are two reasons for donor and recipient incompatibility: pairs are ABO incompatible. For example, a B recipient with an A
donor will not work and an A recipient with a B donor will not work.
ABO blood type and immunologic incompatibility due to recipient But put the pairs into an exchange and A can donate to A and B to
antibodies directed against the donor. Both types can exist together. B so that both patients are transplanted. This type of swap may be
ABO blood types for transplant are similar to transfusion, with type extended to 3, 4 or more pairs. (See Figure 1 – page 22)
O being a universal donor. Donor specific antibodies (DSAs) re-
sponsible for incompatibility result from exposure to foreign, non- Another type of exchange may begin with an altruistic, non-di-
self antigens from pregnancies, previous transplants or prior blood rected donor, i.e., someone who comes forward to donate a kidney
transfusions. to anyone. This may start a chain of transplants as shown in Figure
20 San Antonio Medicine • April 2016 continued on page 22
