Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

Table 1 Demographic and HLA data

	Age/gender	Blood group	Weight (kg)	HLA
				A		B		Bw		Cw		DR B1		DRB3,4,5		DQ B1
Patient 1	26/male	A+	37	3	32	40	-	6	-	3	15	4	10	53	-	5	8
Donor 1	25/female/wife	A+	65	3	24	40	58	4	6	3	12	17	11	52	-	2	7
Patient 2	51/male	B+	60	2	-	40	-	6	-	15	-	10	-	-	-	5	-
Donor 2	45/female/wife	A+		2	26	8	40	6	-	7	15	10	17	52	-	5	2
Patient 3	52/male	A+	52	2	3	44	56	4	6	4	7	7	14	52	53	2	5
Donor 3	45/female/wife	B+	70	2	31	40	55	6	-	1	15	13	15	51	52	6	-

Three-way KPD exchange: Patient 1, 2 and 3 received kidney from donor 2, 3, 1 respectively; KPD: Kidney paired donation.

Table 2 Immunologic data in patient 1 and our cost of immune monitoring and desensitization therapy

Patient 1	Before desensitization	After desensitization
With wife donor
DSA (MFI)	A24-4924, B58-9767, DR11-13112, DR17-13598, DQ7-13194, DQ2-14751	A24-1000, B58-7055, DR11-4296, DR17-1925, DQ7-11838, DQ2-2410
AHG-CDC LCM (%)	80	20
T FCM (MCS)	212	Negative
B-FCM (MCS)	504	328
With KPD donor
DSA (MFI)	B8, 6830: DR 17, 14751: DQ2, 13112	B8, 2400: DR 17, 1925:
		DQ2, 2410
AHG-CDC (%)	20	17
T-FCM (MCS)	88	Negative
B-FCM (MCS)	335	190
The cost of immune monitoring and desensitization therapy (USD)
AHG-CDC LCM		20
T and B FCM		100
DSA ( Luminexx, qualitative)		40
DSA ( Luminexx, quantitative)		425
HLA (class 1 and 2)		200
Plasmapheresis		300
Bortezomib (Baximib, Ranbaxy) 2 mg		60
IVIg (Plasmaglob, Plasmagen) 5 gm		125
Rabbit anti-human thymocyte immunoglobulin (Thymoglobulin, Genzyme-Sanofi) 25 mg		200
Valganciclovir (Cymgal, Biocon) 450 mg		3
Methyl prednisolone ( Solumedrol, Pfizer) 125 mg		4

DSA: Donor specific antibody; AHG-CDC-LCM: An anti-human, globulin-enhanced, complement-dependent cytotoxicity lymphocytotoxicity cross matches; FCM: Flow cross match; MCS: Median channel shift; MFI: Mean fluorescent intensity; KPD: Kidney paired donation.

Table 3 Pre-transplantation and surgical data and outcome

	Patient 1	Patient 2	Patient 3
Cause of ESRD	Chronic glomerulonephritis	Hypertension	Hypertension
Dialysis duration (mo)	24	6	6
KPD waiting time (mo)	6	2	2
Warm ischemia time (s)	120	157	180
Cold ischemia time (min)	90	67	30
Anastomosis time (min)	22	23	25
Intra-operative urine output (mL)	800	1500	700
Laparoscopic donor nephrectomy	Yes	Yes	Yes
Rejection/ complications	No	No	No
Creatinine at discharge (mg/dL)	1	0.9	0.8
Creatinine at 24 mo (mg/dL)	1.4	0.8	0.8

ESRD: End stage renal disease; KPD: Kidney paired donation.