title: Exchange living-donor kidney transplantation: merits and limitations.
abstract: BACKGROUND
  The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce.
  
  
  METHODS
  From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program.
  
  
  RESULTS
  The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007).
  
  
  CONCLUSIONS
  We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyu Ha
authors.initials: KH
authors.lastname: Huh
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Ju
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Chang
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Ahn
authors.forename: Su Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Yu Seun
authors.initials: YS
authors.lastname: Kim
authors.forename: Kiil
authors.initials: K
authors.lastname: Park
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D001788:Blood Grouping and Crossmatching; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D016030:Kidney Transplantation; D007723:Korea; D019520:Living Donors / Q000600:supply & distribution*; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens