Bootcongres

A recent analysis of 9 years national donor-exchange program showed that from 232 cross-match positive participating pair candidates 51% could find a HLA compatible match and are transplanted successfully. Reasons for outflow were amongst others; postmortal transplantation (13%), transplantation with other direct living donor (7%), transplanted in the context of domino-paired program (5%), delisted because of medical reasons (17%), and still waiting (7%). Not surprisingly, the median PRA among successfully transplanted group of cross-match positive candidates was significantly lower than among those who could not find a match (PRA median± range: matched group: 48% vs. not-matched group: 75%, ± 2-100%). Interestingly, about 60% of participating cross- match positive candidates could find a match after a total number of 4 rounds. However, the chances for transplantation barely increased after 1 year participation in the donor-exchange program, resulting in a prolonged waiting time for a subgroup of patients. Increased waiting time is associated with increased morbidity and mortality among these patients. Thus, there is a need to further develop desensitizing therapies to make transplantation for this particular group of patients feasible. A published analysis of 2323 patients listed on the Rotterdam waiting list for kidney transplantation demonstrated that the alternative living donor transplantation programs marginally contribute to transplantation of highly sensitized patients. A sequential desensitization program after unsuccessful participation in the donor- exchange program will aid the transplantation of sensitized patients with a living donor. Recently, we started a joined effort in the Netherlands to help this group of patients by setting up the HLA incompatible program providing low volume but complex care. The running desensitization protocol along with so far accepted inclusion criteria to participate in this program will be discussed on behalf of the Dutch HLA incompatible working group.