We report the results of a large series of chain transplantations that were facilitated by a multicenter US database in which 57 centers pooled incompatible donor/recipient pairs. Chains, initiated by nondirected donors, were identified using a computer algorithm incorporating virtual cross-matches and potential to extend chains. The first 54 chains facilitated 272 kidney transplants (mean chain length = 5.0). Seven chains ended because potential donors became unavailable to donate after their recipient received a kidney; however, every recipient whose intended donor donated was transplanted. The remaining 47 chains were eventually closed by having the last donor donate to the waiting list. Of the 272 chain recipients 46% were ethnic minorities and 63% of grafts were shipped from other centers. The number of blood type O-patients receiving a transplant (n = 90) was greater than the number of blood type O-non-directed donors (n = 32) initiating chains. We have 1-year follow up on the first 100 transplants. The mean 1-year creatinine of the first 100 transplants from this series was 1.3 mg/dL. Chain transplantation enables many recipients with immunologically incompatible donors to be transplanted with high quality grafts.

Background: To construct a nursing solution for the prevention and control of urinary tract infection (UTI) in the early stage after kidney transplantation, and to provide systematic and standardized nursing intervention measures for patients in the early stage after kidney transplantation. Methods:The preliminary draft of intervention plan was formulated based on risk factor analysis research results of early UTI after kidney transplantation, combined with theoretical research, literature review, and research group meeting. The Delphi method was used to consult 15 experts for two rounds, and the entries were modified according to the opinions of the experts.Results: After two rounds of consultation, the expert opinions tended to be consistent, and expert authority coefficient was 0.87. The Kendall harmony coefficient of importance and feasibility indexes of the two rounds of consultation were 0.407, 0.651 and 0.545, 0.686, respectively, with statistically significant differences (P<0.001). The nursing solution consisted of eight first-level indexes and 35 second-level indexes.The eight first-level indexes included admission symptom evaluation, UTI monitoring, health education, sports intervention, nutrition intervention, ward management, risk factor prevention and nursing, and psychosocial intervention.Conclusions: This study constructed a scientific and reliable nursing solution for the prevention and control of early UTI after kidney transplantation, which is hugely important for guiding clinical nursing work.