title: Exchange donor transplantation: ethical option for living renal transplantation.
abstract: OBJECTIVE
  Taking in consideration the opinion of our team, which necessitates obligation of a relative relation between donors and recipients (genetic or matrimonial), we performed donor exchanges as an ethical alternative in living donor transplantations. We reviewed the outcomes of our exchange series.
  
  
  METHODS
  Between July 2003 and August 2010 we performed 110 exchange donor transplantations in four hospitals: one four-way, two three-way, and 100 two-way cases. Donors were mostly spouses (n = 71) or mothers (n = 15). The mean age of the donors was 48.8 (range = 23-69) and the recipients 41.4 years (range = 5-66). Two were transplanted preemptively and the others had a mean dialysis duration of 43 months (range = 1-120).
  
  
  RESULTS
  Among 110 patients, three compatible pairs joined the group voluntarily; 71, due to ABO incompatibility and 36, due to crossmatch positivity. Induction therapy was used in 92 patients. HLA mismatches (MM) were: one MM in three; two MM in three; three MM in 18, four MM in 36; five MM in 34; and six MM in 18. Among 90 patients tested for panel-reactive antibodies PRA, five showed class I and 10, class II positivity. In 11 patients, B-cell positivity was detected by flow cytometry. Delayed graft function (n = 2), acute rejection (n = 11), BK virus infection (n = 1), and cytomegalovirus infection (n = 3) were seen postoperatively. Three (2.7%) patients died due to sepsis. Five patients returned to dialysis program due to interstitial fibrosis tubular atrophy (IFTA) (n = 2), renal vein thrombosis (n = 1), de novo glomerulopathy (n = 1), or primary nonfunction (n = 1). The 1- and 5-year patient and graft survival rates were 96% and 96%, 95% and 89%, respectively.
  
  
  CONCLUSIONS
  We believe that exchange donor transplantation is as successful as direct transplants; it is a good, ethical alternative to unrelated living transplantations.
authors.affiliation: Gaziosmanpasa Hospital, Istanbul, Turkey. alpgurkan@superonline.com
authors.forename: A
authors.initials: A
authors.lastname: Gürkan
authors.forename: S
authors.initials: S
authors.lastname: Kaçar
authors.forename: C
authors.initials: C
authors.lastname: Varılsuha
authors.forename: S
authors.initials: S
authors.lastname: Tilif
authors.forename: V
authors.initials: V
authors.lastname: Turunç
authors.forename: M
authors.initials: M
authors.lastname: Doǧan
authors.forename: H
authors.initials: H
authors.lastname: Dheir
authors.forename: S
authors.initials: S
authors.lastname: Sahin
mesh_terms: D000328:Adult; D000368:Aged; D004989:Ethics; D005190:Family; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged