1144 ‘Lite’ Delisting – Enabling Kidney Transplant for Highly Sensitised Patients in the Deceased Donor Waiting Pool

Very highly sensitised patients without living donors are unlikely to receive a transplant due to lack of compatible donors. Lite delisting involves removing certain unacceptable antigens from patients’ profiles registered with NHSBT; to achieve a crossmatch negative, antibody positive offer. This project reviews the delisting programme in our centre. The lite delisting programme was initiated in 2018. Patients included in this report were those currently active in the delisted programme and those transplanted since the initiation of the programme. Electronic patient records were reviewed to identify the number of organ offers received. For transplanted patients, clinical outcomes were retrieved. 37 patients received a total of 79 deceased donor offers over the time-period. 19 transplants were completed, 18 in the context of delisting (Alemtuzumab induction). 60 offers were declined (19 because of positive crossmatch results). Of the 19 (10 Female, 9 Male; average 44 years) patients transplanted, 18 had reached a 3-month time point post-transplant. Death censored allograft survival at 3 months was 15 (83%); 1 patient died following a period of primary non-function, two were alive with failed allografts (1 explanted for ischaemia and 1 primary non-function). 1/18 (6.7%) was diagnosed with acute antibody-mediated rejection (graft survived); there were no recorded episodes of T-cell mediated rejection. Mean creatinine of functioning grafts at 3 months post-transplant was 165µmol/L (n=15). Lite delisting is an effective method to allow highly sensitised patients to receive transplants, avoiding the long-term risks of dialysis; although, there are associated risks of transplantation. This methodology could be considered in further Transplant Units.