Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation.
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.
Montgomery
Robert A
RA
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md 21205, USA. rmonty@jhmi.edu
Zachary
Andrea A
AA
Ratner
Lloyd E
LE
Segev
Dorry L
DL
Hiller
Janet M
JM
Houp
Julie
J
Cooper
Mathew
M
Kavoussi
Louis
L
Jarrett
Thomas
T
Burdick
James
J
Maley
Warren R
WR
Melancon
J Keith
JK
Kozlowski
Tomasz
T
Simpkins
Christopher E
CE
Phillips
Melissa
M
Desai
Amol
A
Collins
Vanessa
V
Reeb
Brigitte
B
Kraus
Edward
E
Rabb
Hamid
H
Leffell
Mary S
MS
Warren
Daniel S
DS
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