Paired kidney exchange transplantation: Maximizing the donor pool

Abstract

In the last decade, paired kidney exchange (PKE) transplantation has gained popularity worldwide as a viable alternative for end stage renal disease (ESRD) patients who have incompatible or sensitized donors. This study presents our experience with PKE transplantation and compares outcome between PKE and non-PKE renal transplant recipients. Between February 2010 and November 2013, 742 transplants were performed, of which 26 (3.5%) were PKE transplantations. All were two-way exchanges. PKE recipients were significantly older than non-PKE (46.73 ± 9.71 vs. 40.08 ± 13.36 years; P = 0.012) while donor ages were comparable. PKE patients had significantly higher number of HLA mismatches (5.03 ± 1.14 vs. 3.49 ± 1.57; P < 0.0001). After a median follow-up of 20 months (range: 3–47 months), there was no significant difference in patient survival (PKE 96.16% vs. non-PKE 96.65%; P = 0.596) and death censored graft survival (PKE 96.16% vs. non-PKE 96.37%; P = 1). Mean serum creatinine at 1 month and at last follow-up was lower in PKE versus non-PKE group (0.98 ± 0.33 vs. 1.3 ± 0.61 mg/dl; P = 0.008 and 0.96 ± 0.30 vs. 1.27 ± 0.57 mg/dl, P = 0.006, respectively). Biopsy proven acute rejection rate was 11.5% in PKE group and 16.89% in non-PKE patients (P = 0.6). To conclude, paired kidney donation is an excellent way of increasing the donor pool and needs to be promoted to overcome the shortage of suitable kidney in our country.

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

“…States and other parts of the world. 7,[21][22][23][24] In addition, as recently reported in depth, the shipping of kidneys during paired exchange has not been associated with inferior transplant outcomes. 25 Although the number with primary nonfunction (0.34%) was low, the number with first week dialysis (4.9%) is higher than in-center exchanges.…”

Successful renal transplantation across HLA barrier: Report from India

“…Unlike Western countries where transplants are cadaveric, majority of kidney transplants performed in India are live-related donor transplants. [ 1 2 ] In India, the Human Organ Transplantation Act, 1949 (amended in 2013), governs solid organ transplantation and allows only first-degree relatives including sibling, parents, children, grandparents, grandchildren, and spouse to donate an organ. [ 3 ] However, sometimes these suitable donors may be deferred due to the presence of donor-specific anti-ABO blood group or anti-HLA antibodies in the recipient.…”

Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017

“…In India, in the absence of national KPD program, only single-center KPD is practiced. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ] Table 2 shows the key elements of success of single-center KPD program at the Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India, a center which has performed 300 KPD transplants in India. [ 2 3 4 5 6 7 8 9 10 ]…”

“…Table 3 shows the outcome of KPD from India. [ 2 3 4 5 6 7 8 9 10 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Waigankar et al . [ 28 ] reported inferior outcome of ABOiKT compared to KPD.…”