肾移植供、受者KIR基因和KIR配体相关基因的错配对移植效果的影响

目的 评价肾移植供、受者间自然杀伤细胞免疫球蛋白样受体(KIR)基因、KIR配体HLA-C基因和KIR配体HLA-Bw4I80相关基因的实际错配概率及其对受者急性排斥反应(AR)的影响.方法 对322例肾移植受者以及相应的196例尸体肾移植供者的KIR基因、KIR配体HLA-C基因、KIR配体HLA-Bw4I80相关基因的错配概率进行分析,同时研究KIR配体HLA-Bw4I80相关基因错配与AR发生率及AR逆转率的关系.结果 322例受者与相应供者间KIR-L基因平均错配概率为4.73％,KIR-S基因平均错配概率为9.10％,KIR配体HLA-C基因平均错配概率为1.95％.322例受者中,与相应供者KIR配体HLA-Bw4I80相关基因发生错配的有245例(76.09％),无错配的有77例(23.91％).245例KIR配体HLA-Bw4I80相关基因错配组的AR发生率为8.16％,77例无错配组的AR发生率7.79％(P＞0.05);错配组AR逆转率为95.0％,无错配组AR逆转率为66.7％(P＞0.05).结论 肾移植供、受者间KIR配体HLA-Bw4I80相关基因错配概率较高,其错配对AR逆转的影响尚需进一步大样本研究来验证.     

供、受者ABO血型相容肾移植后并发溶血一例

在供、受者HLA匹配的情况下,接受ABO血型不一致但相容的器官移植,受者绝大多数不会出现溶血性贫血,尤其是当供者的ABO血型为O型时,因为从传统的ABO血型匹配的角度来看,O型血中并不存在抗A抗体和抗B抗体,但也有极少数出现溶血现象.2012年3月,我院施行供、受者ABO血型不一致但相容的肾移植1例,术后受者发生溶血,现报告如下. 临床资料 患者为男性,59岁,ABO血型为A型,RhD为阳性,群体反应性抗体为阴性,既往无输血史,血液透析时间为5个月,术前血红蛋白为94 g/L.供者ABO血型为O型,RhD为阳性.供、受者HLA配型中B和DR位点上的抗原相合.     

腹腔器官移植供受者ABO血型基因型及其随机错配率的研究

目的 探讨腹腔器官移植供、受者的ABO血型基因型的分布频率,分析移植供、受者在ABO血清型相同的基础上的基因型随机错配情况.方法 肾移植受者89例、肝移植受者22例为受者组,同期86名无关随机供者为供者组.两组均采用单克隆抗体检测ABO血清学分型,同时采用聚合酶链反应-序列特异性引物(sequence-specific...     

试管法与凝胶卡法对ABO血型不相合肾移植受者血型IgM抗体效价检测结果分析

目的探讨试管法、凝胶卡法两种方法对ABO血型不相合肾移植受者不同血型抗体效价检测的界值, 为ABO血型不相合肾移植术前抗体效价临界值的选择提供参考依据。方法收集2019年1月至2021年4月期间, 四川大学华西医院泌尿外科行ABO血型不相合214例肾移植受者的681例次血型抗体效价资料, A型135例次, B型168例次, O型378例次。对使用两种方法进行ABO血型IgM抗体效价测定的结果进行差异性、相关性以及一致性的统计分析。结果试管法检测结果比凝胶卡法低2个梯度(4倍稀释), 两种方法检测结果差异有统计学意义(P<0.000 1)。Spearman检验结果提示两种方法的检测结果呈显著相关(P<0.000 1), 组内相关性分析结果显示, 对于A型受者两种方法检测结果的一致性一般[组内相关系数(ICC)=0.640], 对于B型受者检测结果一致性较好(ICC=0.751), 而对于O型受者两种方法检测结果的一致性较差(ICC<0.4)。当试管法检测结果界值设定为:A型抗B效价为16、B型抗A效价为8、O型抗A与抗B效价均为8时, 与之对应的凝胶卡法界值为:A型抗B...     

心脏死亡器官捐献供肾ABO血型不相容肾移植八例临床分析

目的探讨心脏死亡器官捐献(DCD)供肾ABO血型不相合肾移植临床疗效和安全性。 方法回顾性分析中国人民解放军联勤保障部队第九二四医院移植科2016年12月至2018年6月实施的8例DCD供肾ABO血型不相容肾移植受者临床资料,其中男性6例,女性2例,年龄26～54岁,群体反应性抗体(PRA)阳性4例,二次肾移植2例,供受者Rh(D)血型均为阴性。根据受者初始血型抗体效价及术前PRA抗体水平制定个体化预处理方案。术后常规监测受者免疫抑制剂血药浓度,重点监测尿量、肾功能、凝血状态和血型抗体水平,PRA阳性受者注意监测供者特异性抗体水平。 结果8例受者经个体化预处理后肾移植手术当天血型抗体IgG效价水平均≤1∶16。术后2周内7例受者血型抗体无反弹。截至2018年6月,8例受者平均随访时间6～18个月。病例1于术后第2周发生体液性排斥反应,采用蛋白A免疫吸附及大剂量丙种球蛋白冲击治疗后恢复。病例2术后2 h出现膀胱出血,持续膀胱冲洗保守治疗后止血,移植肾功能恢复正常。病例3术后第5个月并发严重肺部真菌感染,抗真菌治疗失败后并发呼吸衰竭死亡。病例6术后出现移植肾功能延迟恢复,予血液透析处理后恢复。病例7术后尿量少,术后第4天出现右下肢深静脉血栓(移植肾侧),行下腔静脉滤网植入及溶栓抗凝治疗,效果欠佳,移植肾失功后恢复血液透析治疗。病例8术后第2个月并发药物性糖尿病,目前血糖控制较好。其余2例受者移植肾功能恢复良好。 结论根据受者初始血型抗体效价及PRA水平进行个体化预处理,可安全、有效地实施DCD供肾ABO血型不相容肾移植。     

亲属活体供肾移植62例经验

目的 总结活体供肾移植的临床经验,提高其临床疗效.方法 同顾分析62例活体供肾移植的临床资料及供者情况.62例中,60例为三代内直系亲属供肾,2例为夫妻问供肾.移植前按程序对供、受者进行评估.供、受者 ABO血型均相同,供、受者间补体依赖淋巴细胞毒均为阴性,受者群体反应抗体阳性2例.53例行HLA配型,其中无抗原错配者5例,1个抗原错配者5例,2个抗原错配者20例,3个抗原错配者18例,4个抗原错配者2例,5个抗原错配者2例,全错配者1例.取左肾51例,取右肾11例.采用抗CD25单克隆抗体及甲泼尼龙(MP)诱导者36例,单纯采用MP者26例.术后采用环孢素A(或他克莫司)霉酚酸酯及泼尼松方法排斥反应.结果 供者住院时间为(9.4±2.2)d,取肾前血肌酐(Cr)为(66.8±16.4)μmol/L,取肾后第1天、第7天以及3个月以后的血Cr分别为(109.3±23.6)ttmol/L、(101.1±24.4)μmol/L和(91.1±15.5)tanol/L,虽明显高于取肾前(P＜0.05),但仍在正常范围.供肾热缺血时间为(70.9±41.7)s,冷缺血时间为(148.2±37.4)min.供者术后的并发症有气胸(3例,4.8%)、淋巴漏(2例,3.2%),切口愈合延迟(2例,3.2%),经治疗后痊愈.受者随访最长者达42个月,人、肾1年存活率均为100%.术后并发症包括急性排斥反应6例(9.7%),移植肾功能恢复延迟4例(6.5%),移植肾破裂1例(1.6%),移植肾动脉吻合口狭窄1例(1.6%),骨髓抑制2例(3.2%),有症状的巨细胞病毒感染3例(4.8%),一过性肝功能异常12例(19.4%),结核2例(3.2%).结论 活体供肾移植的长期效果良好,并发症少;活体供肾是安全的;完善的术前评估程序是保障供、受者良好预后的关键之一.     

国内首例夫妻间配对交换捐肾肾移植报告

目的 回顾分析国内首例夫妻间配对交换捐肾肾移植的资料.方法 2006年4月2对夫妻进行了配对交换捐肾肾移植.受者1为男性,血型为O型;供者1为受者1的妻子,血型为A型.受者2为女性,血型为A型,曾接受过肾移植,移植肾功能衰竭后等待再次肾移植;供者2为受者2的丈夫,血型为O型.2对供、受者均在充分知情的情况下自愿同意与另一对进行交换配对肾移植.结果 移植手术均顺利.受者1移植肾共计存活21个月,受者于移植后30个月时死亡.受者2移植肾存活30个月,受者于移植后31个月时死亡.供者手术后均健康存活.结论 亲属配对交换捐肾肾移植的临床实施应该在严格的医学标准、伦理学标准以及明确的政策法规框架下进行.     

Rh血型阴性尿毒症患者接受Rh阳性亲属活体供肾移植一例

我科近期收治 1例Rh血型阴性尿毒症患者 ,接受Rh阳性同胞弟弟活体供肾移植 ,获得成功 ,现报告如下。患者为男性 ,33岁 ,诊断慢性肾功能不全 1年余 ,于2 0 0 3年 2月 2 1日行活体供肾移植。患者的ABO血型为A型 ,Rh阴性。供者为其同胞弟弟 ,2 8岁 ,ABO血型为A型 ,Rh阳性 ,其自身情况适合提供活体供肾。供、受者HLA配型完全吻合 ,淋巴细胞毒交叉配合试验为 0 .0 2。取供者的左肾 ,以高渗枸橼酸盐腺嘌呤液 (HC A)液 5 0 0ml充分灌洗至流出液清亮。供肾热缺血时间 1min ,冷缺血时间 2h。供肾移植于受者右侧髂窝 ,开放血流后肾脏颜色鲜红 …     

亲属活体供肾移植术中供肾二次缺血再灌注二例报告

例1为男性,28岁,因"慢性肾功能衰竭尿毒症期"入院,病程3年,行规律血液透析治疗2年.患者于2005年9月接受亲属活体供肾移植,供者为受者的同胞哥哥.供、受者ABO血型均为O型,HLA抗原2个错配,群体反应性抗体(PRA)阴性,淋巴细胞毒交叉配合试验阴性.     

儿童肾移植受者移植术后一年内发生急性排斥反应的影响因素及预后分析

目的探讨儿童肾移植受者移植术后一年内发生急性排斥反应(acute rejection, AR)的影响因素及AR发生时间对预后的影响。方法选取2011年1月至2021年10月浙江大学医学院附属第一医院肾脏病中心移植时年龄小于18岁的肾移植受者, 在排除6例非排斥反应导致的早期移植肾功能丧失受者后, 最终有106例受者纳入本次研究。其中, 男63例, 女43例;年龄15(12, 16)岁;供体来源为亲属供肾26例, 尸体供肾80例。根据是否发生移植肾AR及AR发生时间, 将其分为一年内发生AR组、一年后发生AR组和未发生AR组。回顾性对比分析3组儿童肾移植供、受者的临床特征、AR发生的影响因素和治疗结果。通过单因素方差分析或Kruskal-Wallis检验比较3组AR发生后一年的肾功能情况;以移植肾功能丧失作为随访终点事件, 采用Kaplan-Meier生存曲线分析一年内发生AR和一年后发生AR对移植肾生存率的影响。结果 106例儿童肾移植受者的中位随访时间为35个月, 有17例(16.0%)儿童受者出现了19次AR事件, 另89例受者截至随访终点未发生AR(未发生AR组)。其中一年内发生...     

The effect of mismatching for HLA-DR in recipients of renal allografts sharing one HLA-ABC haplotype with related donors

The effects of mismatching for DR antigens on renal allograft survival rates have largely been restricted to analyses of cadaver transplant results. Analyses of HLA matching in recipients of transplants from related donors have focused on the number of haplotypes shared between the recipients without regard to DR, or on the total number of HLA antigens mismatched, or on the degree of MLC responsiveness of the recipient to the donor. Most related donor-recipient pairs sharing only one HLA haplotype will be mismatched for DR at the other haplotype, but because there are a limited number of DR alleles, sharing of DR antigens on the mismatched haplotypes occurs relatively frequently. To determine the influence of mismatching for DR on the fate of renal allografts from related donors, we analyzed the results of 172 kidney transplants from related donors who shared one HLA-ABC haplotype with the recipient. There were 156 primary grafts and 16 retransplants; 147 donor-recipient pairs were satisfactory typed for DR antigens. Because genotyping was not usually done, we performed two analyses under two different assumptions. The first assumption was that individuals expressing less than or equal to 1 DR antigen had null antigens, or were homozygous for DR; the alternative assumption was that blanks were true antigens and individuals with blanks were heterozygous. The first assumption is more likely to be correct, and is the assumption used in most analyses of the effect of DR antigen mismatches on the results of cadaveric transplantation. Under the first assumption, of the 147 related donor-recipient pairs in whom DR typing was satisfactory, 33% were mismatched for 0, 64% for 1, and 3% for 2 DR antigens. The one-year absolute graft survival rates in recipients of kidneys from donors with 0 mismatches for DR was 92% (n = 49); in those with one mismatch for DR it was 82% (n = 94); and from those with two mismatches it was 50% (n = 4). The one-year graft survival rate in 25 donor-recipient pairs in which one or both members could not be satisfactorily DR typed was 76%. Differences in graft survival rates between the 0 and 1 and the 1 and 2 DR-mismatched groups were not statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)     

The Dutch algorithm for allocation in living donor kidney exchange

The shortage of kidneys from brain-dead donors for transplantation has made it necessary to look for alternatives. Living kidney donation is one possibility. However, because of ABO blood group incompatibility or immunological reasons, transplantation of kidneys from a living donor is not always possible. The seven Dutch kidney transplantation centers have developed a joint protocol for crossover, or paired donor exchange, kidney transplantation. To ensure a fair chance for all participating donor-recipient pairs, the Dutch Transplantation Foundation has developed an allocation algorithm to match compatible donor-recipient pairs. A crossover match is performed every 3 months. The computer program developed by the Dutch Transplantation Foundation to match compatible donor-recipient pairs calculates the match probability (MP) of every potential recipient. The MP takes into account the peak panel-reactive antibodies (%PRA) of the recipient, the incidence within the crossover donor population of (compatible) ABO blood group, and HLA unacceptables of the recipient. The potential recipient with the lowest MP, in other words, the recipient with the smallest chance of finding a compatible donor in the pool, is ranked first. Until now, three matches have been performed in the Netherlands. A total of 53 pairs from all seven Dutch transplantation centers have participated. For 22 of the pairs a compatible donor-recipient pair was found.     

Utilization of hepatitis C antibody-positive livers: genotype dominance is virally determined

Because of the unrelenting donor shortage, utilization of all potential liver donors is essential. However, when utilizing marginal donors it is critical to precisely characterize the risks, inform recipients of those risks, and allocate these higher risk organs to appropriate candidates. Towards this goal, we need to determine the safety and potential consequences, if any, of utilizing hepatitis C (HCV) antibody-positive donors in HCV infected recipients. To further characterize HCV antibody-positive donors, we analyzed prospectively collected serum samples from HCV antibody-positive donors transplanted into HCV RNA-positive recipients from 5/1993 to 10/2008 for HCV viral load (Roche Cobas AmpliPrep/Cobas Taqman HCV Assay) and genotype (Siemens Versant 2.0 LiPA HCV 5' UTR/Core Assay). Seventeen of 32 (53%) HCV antibody-positive donors were RNA negative. Fifteen patients received an HCV RNA-positive donor and nine donor-recipient pairs had different genotypes or subtypes for analysis. When genotype 1 competed with a non-1 genotype, it was found in 5/6 recipients. In 2/3 cases of mismatched genotype 1 subtypes, genotype 1a dominated. Kaplan-Meier analysis of patient and graft survival and fibrosis progression did not reveal differences between patients who received an HCV antibody-positive donor that was viremic or aviremic. In conclusion, approximately half of HCV antibody-positive donors were aviremic. Viral dominance in viremic donor-recipient pairs seems virally determined.     

Hemolytic anemia after ABO nonidentical living donor kidney transplantation

Introduction  ABO compatible non-identical kidney transplants are used frequently. Acquired hemolytic anemia has been reported after ABO mismatched transplantation. Patients of A, B or AB blood groups may receive organs from ABO-compatible, but non-identical donors, mostly from O blood group donors. It may also occur in patients of the AB blood group who receive a kidney from a donor of the A or B blood groups. Patients and methods  ABO non-identical living donor kidney transplantation was done in 214 cases. All studied patients received kidneys from one haplotype HLA mismatched living donors and had pretransplant non-specific blood transfusions. There were 164 males and 50 females with a mean age of 30 years. Ten patients with cyclosporine (CsA)-based therapy developed hemolysis. CsA was stopped in patients maintained on triple immunosuppression (pred, CsA, AZA) and shifted to azathioprine in patients maintained on pred CsA therapy. In all patients pretransplant antibody screen, direct antiglobulin test (DAT) and cytotoxic cross match were all negative. Results  The prognosis was excellent in nine patients, and one died from severe hemolysis. Hemolytic anemia was more frequent among blood group A recipients (60% of our cases) and more severe among recipient blood group B. Six patients received antigen-negative packed RBCs. Univariate analysis demonstrated significant impact for recipient age, donor sex, number of pretransplant blood transfusions, primary immunosuppression, time to onset of diuresis, recipient and donor blood groups. Multivariate analysis restricted the significance to blood group of donor and recipient, time to onset of diuresis and primary immunosuppression. Conclusions  Post transplant hemolysis is infrequent after renal transplantation; however, it may occur with compatible, non-identical ABO blood group donors. Blood group of donor and recipient, time to onset of diuresis and primary immunosuppression (mainly CsA) were significant risk factors in hemolytic anemia in patients after ABO non-identical living donor kidney transplantation. The condition is usually mild and self limited, and change of immunosuppression (stop CsA) can treat the condition.     

Literature Review of Passenger Lymphocyte Syndrome Following Renal Transplantation and Two Case Reports

Passenger lymphocyte syndrome (PLS) is an immune‐mediated hemolysis. It occurs following ABO blood group mismatched solid organ and/or bone marrow transplantation between donor and recipient. We report two cases of PLS occurring after renal transplantation. Both recipients received live related kidney transplants; one from his mother and the other from his brother. The direction of blood group transfer, from donor to recipient, was O Rh D+ to A Rh D+ in both cases. Approximately 12 days after transplantation, both recipients showed a rapid fall in their hemoglobin levels with no identifiable bleeding source. DAT positive hemolysis was confirmed and anti‐A antibodies were detected in recipient sera, confirming a diagnosis of PLS. Both cases required blood transfusion support to maintain their hemoglobin and both had good renal outcomes. We have identified 99 PLS cases following renal transplant in the English literature. Previous ABO sensitization, donor blood group O to recipient blood group A or B transfer, and ciclosporin treatment have been identified as risk factors for PLS. Clinical outcomes in general are good; nonetheless, cases of graft failure and deaths have been reported. Early diagnosis and appropriate treatment are important in at risk individuals.     

Impact of donor and recipient cytokine genotypes on renal allograft outcome

Allelic differences in gene promoter or codifying regions have been described to affect regulation of gene expression, consequently increasing or decreasing cytokine production and signal transduction responses to a given stimulus. This observation has been reported for interleukin (IL)-10 (-1082 A/G; -819/-592 CT/CA), transforming growth factor (TGF)-beta (codon 10 C/T, codon 25 G/C), tumor necrosis factor (TNF)-alpha (-308 G/A), TNF-beta (+252 A/G), interferon (IFN)-gamma (+874 T/A), IL-6 (-174 G/C), and IL-4R alpha (+1902 G/A). To evaluate the influence of these cytokine genotypes on the development of acute or chronic rejection, we correlated the genotypes of both kidney graft recipients and cadaver donors with the clinical outcome. Kidney recipients had 5 years follow-up, at least 2 HLA-DRB compatibilities, and a maximum of 25% anti-HLA pretransplantation sensitization. The clinical outcomes were grouped as follows: stable functioning graft (NR, n = 35); acute rejection episodes (AR, n = 31); and chronic rejection (CR, n = 31). The cytokine genotype polymorphisms were defined using PCR-SSP typing. A statistical analysis showed a significant prevalence of recipient IL-10 -819/-592 genotype among CR individuals; whereas among donors, the TGF-beta codon 10 CT genotype was significantly associated with the AR cohort and the IL-6 -174 CC genotype with CR. Other albeit not significant observations included a strong predisposition of recipient TGF-beta codon 10 CT genotype with CR, and TNF-beta 252 AA with AR. A low frequency of TNF-alpha -308 AA genotype also was observed among recipients and donors who showed poor allograft outcomes.     

The “ABO Cross-transplantation Problem” in Liver Transplantation in Korea

ABO blood group matching policy between donor and recipients is a chief element of organ allocation. However, O blood group donors may donate to all other blood group recipients, and ABO cross-transplantation has led to excessively long delays for blood group O. To investigate the consequence of this problem, we analyzed the recipients/donor rates according to ABO blood groups and cross-transplantation rates among them. Data about deceased donors and liver transplants performed in Korea from January 2008 to September 2012 were reviewed. The proportion of recipient to donor in the O blood group was lower compared to non-O groups (0.61). The percentage of O blood group transplantations in the Korean Network for Organ Sharing (KONOS) status 2B was lower than non-O groups (13.6%). In the status 1 and 2A groups, 44.4% of O blood group donors were allocated to non-O transplantations. Also, 30.7% O blood group donors were allocated to non-O transplantations in the status 2B groups. In conclusion, the ABO cross-transplantation in blood group O donors has led to lower transplantation rates of blood group O in status 1, 2A, and especially, the 2B group. Therefore, the KONOS allocation system should be re-evaluated to address this problem.     

Ethical issues in increasing living kidney donations by expanding kidney paired exchange programs

INTRODUCTION: In 1997, Ross et al. proposed to increase the supply of living kidney donations by using kidneys from living ABO-incompatible donors through an exchange arrangement between two living kidney donor-recipient pairs. Although many transplant centers are exploring this option, only a small fraction of potential donor-recipient pairs are eligible for an exchange on the basis of ABO incompatibility. In this article, we explore three variations that have potentially great clinical relevance. METHODS: The three potential variations discussed are: (1) altruistically unbalanced living donor-recipient exchanges; (2) an indirect exchange (an exchange between a living donor-recipient pair with a cadaveric donor-recipient pair) on the basis of a positive crossmatch; and (3) an indirect exchange on the basis of ABO incompatibility. DISCUSSION: The goal of kidney paired exchange programs is to increase the supply of kidneys available for transplantation ethically. We acknowledge that all exchanges increase the potential for coercion, and we currently reject the proposal of altruistically unbalanced exchanges because of the potential for coercion. However, we believe that voluntary consent can be achieved for indirect exchanges. The indirect ABO-compatible exchange creates no new ethical concerns to our original living paired exchange program and we support its implementation. The indirect ABO-incompatible exchange does create a new ethical concern because it may increase the vulnerability of O blood group recipients. If mechanisms can be developed to avoid increasing the waiting time for blood group O recipients, we would support the implementation of the indirect ABO-incompatible exchange.     

Similar renal allograft functional survival rates for kidneys from sibling donors matched for zero-versus-one haplotype with the recipient

From January 1968 to December 1983, 536 primary renal transplants from siblings donors were performed at a single institution; of the donor-recipient pairs, 246 were matched for two, 205 for one, and 43 for zero HLA haplotypes. Renal allograft functional survival rates at two years were 93%, 75%, and 83% for the 2, 1, and 0-haplotype matched pairs. Corresponding patient survival rates were 95%, 85%, and 93%. The functional survival rate of grafts from the HLA-identical sibling donors was significantly better than the rates in both mismatched donor groups (P = .004), but the difference between the one-haplotype and the zero-haplotype matched pairs was not significant. Most transplant units do not perform transplants between siblings mismatched for both haplotypes because it is assumed that the graft survival rates will be inferior to what can be achieved with a one-haplotype match, and that the outcome will be no better than with cadaveric transplantation. Our results do not support that presumption. Although HLA-identical siblings are the best donors, a sibling should not be excluded as a donor simply because he or she is a complete mismatch. The graft survival rate (83%) is still superior to that achieved with cadaveric transplants (64% at two years, n = 618), and is at least as good as that achieved with transplants from siblings matched for one HLA haplotype. The advent of donor-specific blood transfusion has resulted in liberalization of criteria for acceptance of related donors, but the results of our analysis suggest that a liberal policy, at least in regard to haplotype matching, has always been justified--and certainly at this time the recipient with a willing living donor, regardless of match, should not be relegated to receive a cadaver graft (a scarce resource) that could otherwise be transplanted to someone else who does not have a related donor.     

Characteristics of compatible pair participants in kidney paired donation at a single center

Compatible pairs of living kidney donors and their intended recipients can enter into kidney paired donation (KPD) and facilitate additional living donor kidney transplants (LDKTs). We examined 11 compatible pairs (the intended recipients and their intended, compatible donors) who participated in KPD, along with the recipients’ 11 matched, exchange donors. The 11 pairs participated in 10 separate exchanges (three were multicenter exchanges) that included 33 total LDKTs (22 additional LDKTs). All the intended donors were blood group O and female, with a mean living kidney donor profile index (LKDPI) of 27.6 (SD 16.8). The matched donors had a mean LKDPI of 9.4 (SD 31.7). Compatible pairs entered KPD for altruistic reasons (N=2) or due to mismatch of age (N=7) or body/kidney size (N=2) between the recipient and intended donor. In four cases, retrospective calculation of the LKDPI revealed that the matched donor had a higher LKDPI than the intended donor. Of the 22 recipients of LDKTs enabled by the compatible pairs, three were highly sensitized, with PRA >80%. In conclusion, most compatible pairs entered into KPD so that the recipient could receive a LDKT transplant from a donor whose age or body/kidney size were more favorable to post‐transplant outcomes.