title: Renal transplantation at the Johns Hopkins Comprehensive Transplant Center.
abstract: A stagnant supply of transplantable organs in the face of a relentless burgeoning of transplant waiting lists has created a crisis. Necessity continues to be the mother of invention and as the crisis has deepened it has served as a crucible for the development of new ways to think about perennial problems. Our program has taken a 2-pronged approach to increasing the organ supply for our patients. First, through innovations like the laparoscopic donor nephrectomy, ABO-incompatible and positive-crossmatch transplantation protocols, unconventional paired kidney exchanges, and the use of altruistic donors we have more than doubled our utilization of live donor organs. At the same time, we have developed algorithms and interrogative techniques to enhance the intelligent use of kidneys from expanded criteria donors for patients who do not have an available live donor. The laparoscopic nephrectomy has proven to be a safe and effective way of removing a significant barrier to live donation. Our results from 100 ABOi, (+)XM, and PKE transplants are similar to national statistics for compatible live donor transplants, suggesting that existing paradigms of compatibility can be safely expanded. These encouraging early outcomes and the savings they transmit to the health care system have allowed us to obtain insurance coverage for the InKTP programs, setting the stage for further expansion of these opportunities to broaden the options for patients with end-stage renal disease.
authors.affiliation: The Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.forename: Edward
authors.initials: E
authors.lastname: Kraus
authors.forename: Hamid
authors.initials: H
authors.lastname: Rabb
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Richard M
authors.initials: RM
authors.lastname: Ugarte
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zachary
mesh_terms: D000017:ABO Blood-Group System; D000046:Academic Medical Centers; D000533:Altruism; D000906:Antibodies / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D001787:Blood Group Incompatibility; D003587:Cytomegalovirus / Q000276:immunology; D003888:Desensitization, Immunologic; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization; D007136:Immunoglobulins / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology; D010535:Laparoscopy; D019520:Living Donors; D008396:Maryland; D009392:Nephrectomy / Q000379:methods; D009926:Organ Preservation / Q000379:methods; D010477:Perfusion; D010956:Plasmapheresis; D009927:Tissue and Organ Procurement / Q000379:methods
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D007136:Immunoglobulins