We feel kidney transplantation can offer patients with end-stage renal disease the best quality of life.  Despite tremendous public awareness and education efforts, the number of deceased donor organs available has remained fairly steady over the past decade while the number of people waiting for transplants has greatly increased.

Therefore, living donors represent the most promising alternative for kidney patients receiving dialysis or approaching the need for dialysis.  Unfortunately, upon first review, approximately 30 percent of all live donors do not match their intended recipient. Recipients may be either blood group incompatible (ABO incompatible) with their intended donor or have other pre-formed antibodies against the intended donor.  The Rogosin Institute now has programs available to increase the possibility for recipients to receive successful transplants from a recipient who was previously thought to be incompatible.

Recipient Pre-conditioning (Desensitization) Program

For recipients who have antibodies directed towards their donor including transplants between ABO Incompatible Recipients and Donors

It is not uncommon for prospective kidney transplant recipients to find out that they have acquired antibodies directed against a willing living donor.  Situations after which these types of antibodies may develop, include blood transfusions, pregnancy or viral infections. A similar situation exists when a recipient and their donor are found to have ‘incompatible’ blood groups, i.e. are ABO incompatible. 

Our extensive experience has shown us that the detection of donor-directed antibodies, including the naturally occurring antibodies to different blood groups, does not mean that the planned transplant has to be abandoned, but rather that closer study is necessary.  The tissue typing laboratory of the Rogosin Institute is world renowned and in conjunction with the blood bank at the New York Presbyterian Hospital/Weill Cornell Medical Center, they are uniquely suited to identify, and using the most sensitive assays, quantify these antibodies.  

The results are then reviewed by our transplant team and if it is felt that it is safe to go forward with a high likelihood of success, an individualized, outpatient, pre-conditioning program including: (1) depleting the cells that produce these antibodies, and (2) depleting the antibodies themselves, is prescribed.   The entire prescription, including intravenous infusions, immunosuppressive medications and plasma exchange treatments, may take a number of weeks.  As the course of therapy approaches completion, frequent monitoring to determine successful antibody depletion allows us to optimize the time to perform a successful transplant.   In fact, over 90 percent of the transplants that are performed after pre-conditioning sensitized or ABO incompatible donor transplant recipients are successful.

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Live Kidney Donor-Recipient Exchange Program

The Kidney Donor-Recipient Exchange Program was created to offer live kidney donation opportunities to incompatible donor-recipient pairs.  The prospective recipient in the enrolled donor-recipient pair may have either ABO antibodies or other sensitizing antibodies that increase the risk of rejection and markedly decrease the likelihood of a successful transplant.  The program uses a registry to match incompatible donors and recipients.

Donor-recipient pairs undergo routine pre-transplant evaluation, including testing for blood type and tissue compatibility.  If incompatibility is present, the donor-recipient pair is asked if they would like to be evaluated for the recipient pre-conditioning program (see above) or join the registry, which seeks to match incompatible pairs so that several, successful, matched transplants can be performed.

The process is successful if the donor in one pair (Pair 1) is matched with the recipient in another pair (Pair 2) and the donor in Pair 2 is matched with the recipient in Pair 1. (See diagram). When the matches are made, four surgeries are scheduled. More donor recipient pairs may be included in the exchange.  (e.g. this can be between three or more recipient pairs)

We also encourage ‘altruistic’ donors to enroll in the registry of Donor-Recipient Exchange Program.  The enrollment of one altruistic donor may trigger a series of matched living donor transplants.

The pre-transplant program at the Rogosin Institute participates in regional donor-recipient exchange programs.  This increases the likelihood of a successful exchange by increasing the number of pair options for all enrollees.
 
More than 90 percent of living donor kidney transplants between unrelated matched pairs are successful. In fact, unrelated living donor transplants are as successful as most matched related living donor transplants.

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