Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

Abstract

In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n = 222), positive cross-match (n = 59) and better matching (n = 19). A total of 124 two-way (n = 248), 14 three-way (n = 42), one four-way (n = 4) and one six-way exchange (n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n = 288) and 83.3% (n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist.

Broken Chains and Reneging: A Review of 1748 Kidney Paired Donation Transplants

“…As previously noted in a report by Kute et al, this means that a donor whose surgery is scheduled to begin even a few minutes or hours after the intended recipient has received a kidney retains the ability to back out and disrupt the sequence of planned transplants (15). In their 2009 simulation analysis comparing two different chain strategies (DPD and NEAD), Gentry et al estimated a bridge donor renege rate of 5% per month for NEAD chains.…”

The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries

“…This may be explained by the fact that the majority of NKR transplants were both ABO compatible and HLA crossmatch negative. When KPD exchanges produce compatible transplants, excellent results have been reported in both the US and other parts of the world [7, 20–23]. In addition, as recently reported in depth, the shipping of kidneys during paired exchange has not been associated with inferior transplant outcomes [24].…”

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“…1 This 4-way KE shows the team work and high level of cooperation of people from 3 different states involved in performing such an extensive procedure and how KE can benefit the 4 lives involved in the procedure. Four lives were saved as a result of this 4-way KE.…”

“…Once the incompatible pairs gave written informed consent for KE, they were registered in the KE database with no additional fees or administrative charges. [1][2][3][4][5] All 4 DRPs underwent uniform pretransplant evaluation and posttransplant medical care with the help of standardized HLA and pathology laboratory and a dedicated transplant team. The medical fitness of the 4 DRPs was assessed by the transplant team, which consisted of experts from nephrology, urology, anesthesia, gynecology, and psychiatry departments.…”

“…[1][2][3][4][5][6][7] Traditional 2-way KE, which is the most commonly performed KE (> 80%) in Indian KE transplant programs, has inherent limitations for quality and quantity of matching, mainly in disadvantaged groups like sensitized and O blood group patients. Kidney transplant options for sensitized patients include the use of a compatible donor recipient pair (DRP) or longer KE donor chains, acceptable mismatch KE, international KE, KE combined with desensitization or ABO-incompatible transplant (ABOiKT), living-to deceased-donor exchange, and deceased-donor kidney transplant (DDKT).…”