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Bingaman A, Kapturczak M, Murphey C, Wright F.
(Excerpt) "The kidney paired donation KPD program at Methodist Specialty and Transplant Hospital (MSTH) in San Antonio has significantly increased access to transplantation for patients with incompatible living donors, especially for disadvantaged group such as the highly sensitized population of repeat transplant patients and multiparous women. The KPD program increased overall live donor activity allowing MSTH to become the largest living donor kidney transplant center in the nation in 2009. In 2010, MSTH performed 193 living donor kidney transplants with 68 (35%) transplants from the KPD program. This demonstrates that an effective KPD program can significantly benefit difficult patients and increase transplant access and activity in a single center setting."
Author: Matthew Everly, PharmD
The evidence supporting HLA antibodies as a biomarker in transplant is substantial. It is becoming more clear that these patients represent a new phenotype of patient that is at the highest risk to rapidly progress to chronic damage. Therefore early detection of these high risk patients through serial screening is necessary. Additionally, once patients develop DSA positivity, IgG subclass testing may indicate how eminent his/her graft failure ensue. Moving forward, we should focus monitoring and treating at first detection of persistent antibodies. This may be the only reasonable way to have significant impact on long-term allograft survival.