KIDNEY EXCHANGE PROGRAM FOR HIGHLY SENSIT IZED PATIENTS IN THE SPANISH NORTHERN AREA

This paper describes our experience with a kidney grafts interchange p rogram for hyperimmunized ESRD patients (PRA greater than 75 %) develo ped in the North Region of Spain. Every six months a plate containing serum samples of patients was made and distributed to all the hospital s integrating the program. These serum samples were tested against all organ donors appeared in every hospital. From October 1987 to Decembe r 1991 sixty nine patients included in this program were transplanted. Prevalence of hyperimmunized patients in the waiting list decreased f rom 6 % at the beginning of the program to 4,5 % in 1991. The probabil ity of those patients to be transplanted progressively increased, so t hat 47 % of hyperimmunized patients were transplanted compared with 33 % of the whole group of patients awaiting for a kidney graft. Actuari al graft survival was 60 % at three years. The subgroup of patients tr ansplanted with less than three HLA-A, B, DR mismatches showed a survi val of 90 % at one year compared with a 54 % graft survival for that w ith three or more HLA mismatches (p < 0,001). Patients who had been wa iting for more than 1,5 years had a one year graft survival of 47 % wh ile those who had been waiting for a shorter period survived in 75 % o f cases at one year (p < 0.05). This program has allowed, in an area o f 9,5 million population, a rate of transplantation of hyperimmunized patients comparable to that of non-hyperimmunized patients.