Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation

Department of Surgery, Columbia University, New York, New York, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2005; 294(13):1655-63. DOI: 10.1001/jama.294.13.1655
Source: PubMed


First proposed 2 decades ago, live kidney paired donation (KPD) was considered a promising new approach to addressing the shortage of organs for transplantation. Ethical, administrative, and logistical barriers initially proved formidable and prevented the implementation of KPD programs in the United States.
To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors.
Prospective series of paired donations matched and transplanted from a pool of blood type or crossmatch incompatible donors and recipients with end-stage renal disease (6 conventional and 4 unconventional KPD transplants) at a US tertiary referral center (between June 2001 and November 2004) with expertise in performing transplants in patients with high immunologic risk.
Kidney paired donation and live donor renal transplantation.
Patient survival, graft survival, serum creatinine levels, rejection episodes.
A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up of 13 months (range, 1-42 months), the patient survival rate was 100% and the graft survival rate was 95.5%. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8 mg/dL) (106.1 micromol/L [range, 70.7-159.1 micromol/L]). There were no instances of antibody-mediated rejection despite the inclusion of 5 patients who were highly sensitized to HLA antigens due to previous exposure to foreign tissue. Four patients developed acute cellular rejection (18%).
This series of patients who received transplants from a single-center KPD pool provides evidence that recipients with incompatible live donors, even those with rare blood type combinations or high degrees of HLA antigen sensitization, can receive transplants through KPD with graft survival rates that appear to be equivalent to directed, compatible live donor transplants. If these results can be generalized, broader availability of KPD to the estimated 6000 patients with incompatible donors could result in a large expansion of the donor pool.

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    • "He described use of Eculizumab and splenectomy in combination for resistant AMR but emphasized urgency (within 24 h of AMR onset) to achieve maximum benefit (Orandi et al., 2014b). Despite risks associated with AiT, there is survival benefit compared to staying on dialysis (Montgomery et al., 2005). He confirmed similar findings to Dr Loupy and Professor Higgins of poor graft failure related to antibody strength, defined by MFI, and presence of positive CDC cross-match with over 60% graft failure within 5 years post-transplantation and a hazard ratio of 5.0 for graft loss in cases CDCpositive pretransplantation (P < 0.001). "
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    International Journal of Immunogenetics 02/2015; 42(2). DOI:10.1111/iji.12184 · 1.25 Impact Factor
    • "Showed good results at par with the results found in world literature[89] [Figure 3]. PKE transplants are safe except for the delay in availability of ‘eligible’ pairs. "
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    ABSTRACT: The options available to CKD 5 patients with donor shortage due to incompatibilities is to either get enlisted in cadaver transplant program or opt for three other alternatives viz; ABO-incompatible transplant (ABO-I), ABO-incompatible transplant with Rituximab (ABO-R) or paired-kidney exchange transplant (PKE). At our institute we have performed ABO-I, ABO-R and PKE transplants and we are presenting the results of these transplants performed at our institution. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. To review the options available to CKD 5 patients with incompatible donor. Between January 2008 and June 2011, 7 PKE, 26 ABO-I and 7 ABO-R transplants were carried out at our institute. Evaluation of both the recipients and donors involved biochemical, serological and radiological investigations. In case of PKE, recipients were operated simultaneously in different operation theaters. In ABO-I splenectomy was done while in ABO-R was given. Post-transplant the recipient management protocol remained the same. Expenditure following each transplant was calculated. The graft and patient survival of ABO-I, ABO-R and PKE transplants 12-18 months after transplant were 78.9%:80%, 85.7%:85.7% and 100%:100%, respectively. The inclusion of Rituximab in the transplant protocol appears promising. The existing donor shortage could be addressed by encouraging other options like PKE. The limiting factor for ABO-R and PKE transplants is time and cost, respectively. The decision depends on the informed consent between the patient and the nephrologists.
    Indian Journal of Urology 04/2013; 29(2):114-8. DOI:10.4103/0970-1591.114031
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    • "The advantages with use of organs from DDs are the elimination of the risk to the donor and that an organ can be retrieved together with a large vascular pedicle containing central and vital vessels such as the aorta, vena cava and iliac vessels. Live donation (LD) is practiced in renal transplantation, partial liver transplantation (Montgomery et al., 2005; Olsen and Brown, 2008) and less frequently as segmental pancreas or lung transplantation "
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