Seventy-seven kidney paired donation transplantations at a single transplant centre in India led to an increase in living donor kidney transplantations in 2015

Abstract

BackgroundTo ascertain the validity of kidney paired donations (KPDs) as an alternative strategy for increasing living donor kidney transplantations (LDKTs) in an LDKT-dominated transplant programme since directed kidney transplantation, ABO-incompatible or crossmatch-positive pairs are not feasible due to costs and infectious complications.MethodsThis was a prospective single-centre study of 77 KPD transplantations (25 two-way, 7 three-way and 1 six-way exchange) from 1 January 2015 to 1 January 2016 of 158 registered donor recipient pairs. During this period, a total of 380 kidney transplantations [71 deceased donor kidney transplantations (DDKTs), 309 LDKTs] were performed. The reasons for opting for KPD were ABO incompatibility (n = 45), sensitization (n = 26) and better matching (n = 6).ResultsKPD matching was facilitated in 62% (n = 98) of transplants. In all, 48.7% (n = 77) of the transplants were completed in 2015, whereas 13.3% (n = 21) of the matched patients were to undergo transplant surgery in early 2016 after getting legal permission. The waiting time for KPD was shorter compared with DDKT. The death-censored graft survival and patient survival were 98.7% (n = 76) and 93.5% (n = 72), respectively. In all, 14.2% (n = 11) of patients had acute rejection. Match rates among sensitized (n = 60) and O group patients (n = 62) were 58.3% (n = 35) and 41.9% (n = 26), respectively. Of these, 43.3% (n = 26) and 29% (n = 18) of transplants were completed and 15% (n = 9) and 12.9% (n = 8), respectively, are waiting for legal permission.ConclusionsLDKT increased by 25% in 1 year in our single-centre KPD programme. Our key to success was the formation of a KPD registry, awareness and active counselling programs and developing a dedicated team.

Temporal changes in the composition of a large multicenter kidney exchange clearinghouse: Do the hard-to-match accumulate?

“…We are limited in our ability to comment on what portion of NKR matches required desensitization in order to proceed, as this happens at the transplant center and is not necessarily reported to the NKR. Finally, this study may not be generalizable to other countries with different DDKT allocation systems, and where non-directed donation might not be legal, such as the experience in India as reported by Kute et al (22, 23). Still, this study provides insight into recent trends in transplant candidates registering to the largest KPD clearinghouse in the US.…”

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 ]…”

“…KPD led to an increase in LDKT rate by 25% in 1 year in this single-center KPD program in India. [ 5 ] KPD programs are likely to be facilitated more if there is a national KPD program. Table 3 shows the outcome of KPD from India.…”

“…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.…”

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“…[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).…”