P136 Successful adeptness of donor exchange program in renal transplantation at King Faisal Specialist Hospital Jeddah

Abstract

Aim Different methodologies were established to overcome HLA immunological barriers to match the highly increasing number of patients with end-stage renal disease in Saudi Arabia, which is currently ranged between 120 and 150 patients per million per annum. At our hospital, King Faisal Specialist Hospital Jeddah, we therefore successfully established the desensitization and ABOi renal transplantation. Recently we have started to use a donor exchange program. We hereby report about our experience to overcome the immunological incompatibilities by using this program. Methods We used an IT program with high grade on flexibilities by performing different options including simple two-pair exchanges, more complicated domino exchanges and chain donations. All recipients with willing donors and with high titer HLA antibodies and/or strong positive cross match were included in the program. HLA typing was performed by using One Lambda SSOr and SSP. HLA Antibody Identification, Single Antigen Class I/II and C1q test, was performed by One Lambda. T and B cell IgG XM is performed by FACSCanto II flow cytometer, where the cut-off for positive XM is determined based on normal human studies. Results 20 patients were transplanted successfully by using the donor exchange program within a period of 12 months. Considering a total number of 220 transplanted kidneys during this time, which makes our hospital as the largest center for renal transplantation in Saudi Arabia, we were able to increase the number of transplanted organs significantly by 9% and we continue to extend and optimize our histocompatibility services at the hospital. Conclusions Our experience demonstrates the high efficiency of the donor exchange program in overcoming immunological barriers in renal transplantation. This program provides in some cases also an alternative to the invasive and costly desensitization protocols. Further efforts and thoughts are going on to include deseased donors as well in this successful donor exchange program.