CONTEXT: 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. OBJECTIVE: To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. DESIGN, SETTING, AND PATIENTS: 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. INTERVENTION: Kidney paired donation and live donor renal transplantation. MAIN OUTCOME MEASURES: Patient survival, graft survival, serum creatinine levels, rejection episodes. RESULTS: 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%). CONCLUSIONS: 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.
CONTEXT: 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. OBJECTIVE: To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. DESIGN, SETTING, AND PATIENTS: 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. INTERVENTION: Kidney paired donation and live donor renal transplantation. MAIN OUTCOME MEASURES: Patient survival, graft survival, serum creatinine levels, rejection episodes. RESULTS: 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%). CONCLUSIONS: 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.
Authors: Dorry L Segev; Neil R Powe; Misty U Troll; Nae-Yuh Wang; Robert A Montgomery; L Ebony Boulware Journal: Clin Transplant Date: 2012-03-08 Impact factor: 2.863
Authors: Robert J Stratta; Michael S Rohr; Aimee K Sundberg; Alan C Farney; Erica L Hartmann; Phillip S Moore; Jeffrey Rogers; Samy S Iskandar; Michael D Gautreaux; David F Kiger; William Doares; Teresa K Anderson; Gloria Hairston; Patricia L Adams Journal: Ann Surg Date: 2006-05 Impact factor: 12.969
Authors: Peter Chang; Jagbir Gill; James Dong; Caren Rose; Howard Yan; David Landsberg; Edward H Cole; John S Gill Journal: Clin J Am Soc Nephrol Date: 2012-03-22 Impact factor: 8.237
Authors: Courtenay M Holscher; Kyle Jackson; Alvin G Thomas; Christine E Haugen; Sandra R DiBrito; Karina Covarrubias; Sommer E Gentry; Matthew Ronin; Amy D Waterman; Allan B Massie; Jacqueline Garonzik Wang; Dorry L Segev Journal: Am J Transplant Date: 2018-09-12 Impact factor: 8.086
Authors: Francis L Weng; Tracy Grogan; Anup M Patel; Shamkant Mulgaonkar; Marie M Morgievich Journal: Clin Transplant Date: 2017-04-24 Impact factor: 2.863
Authors: Jeremy M Blumberg; Hans A Gritsch; Elaine F Reed; J M Cecka; Gerald S Lipshutz; Gabriel M Danovitch; Suzanne McGuire; David W Gjertson; Jeffrey L Veale Journal: Kidney Int Date: 2013-05-29 Impact factor: 10.612