title: Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Kidney paired donation and live donor renal transplantation.
  
  
  METHODS
  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.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md 21205, USA. rmonty@jhmi.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zachary
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Ratner
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hiller
authors.forename: Julie
authors.initials: J
authors.lastname: Houp
authors.forename: Mathew
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authors.lastname: Cooper
authors.forename: Louis
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authors.lastname: Kavoussi
authors.forename: Thomas
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authors.lastname: Jarrett
authors.forename: James
authors.initials: J
authors.lastname: Burdick
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kozlowski
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Melissa
authors.initials: M
authors.lastname: Phillips
authors.forename: Amol
authors.initials: A
authors.lastname: Desai
authors.forename: Vanessa
authors.initials: V
authors.lastname: Collins
authors.forename: Brigitte
authors.initials: B
authors.lastname: Reeb
authors.forename: Edward
authors.initials: E
authors.lastname: Kraus
authors.forename: Hamid
authors.initials: H
authors.lastname: Rabb
authors.forename: Mary S
authors.initials: MS
authors.lastname: Leffell
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D009927:Tissue and Organ Procurement; D014181:Transplantation Immunology