title: Eight years of outcomes of the Dutch Living Donor Kidney Exchange Program.
abstract: In January 2004, the Dutch transplant centers agreed on a protocol for a national Living Donor Kidney Exchange Program for ABO blood type incompatible and positive cross match donor-recipient pairs. Here, we report the results of that program. All transplants performed within the Living Donor Kidney Exchange Program between January 2004 and December 2011 were analysed. We collected demographic data of recipients and donors. Univariate and multivariate Cox proportional hazard analyses were performed, including recipient age, donor age, and reason for participation in the exchange program. We studied overall uncensored survival and graft survival censored for death in both ABO blood type incompatible and positive cross match groups. We enrolled 472 donor-recipient combinations, consisting of 269 ABO blood type incompatible pairs and 203 positive cross match pairs. In the end, we performed 187 kidney transplants (40% of those enrolled) with 83 ABO blood type incompatible and 104 positive cross match pairs. Most of the transplanted recipients (119/187, 64%) had an age difference of less than 5 years with their original incompatible donors. The age differences with their actual donors varied widely, but the number of recipients with a donor > 5 years older was comparable to the number of recipients with a donor > 5 years younger. In the multivariate Cox analysis, age as a continuous variable was found to have a significant influence on graft failure. Nevertheless, the 5-year uncensored survival (85%) and the graft survival censored for death (89%) were excellent and comparable to the results of direct living donation. No differences were found between the ABO incompatible and the positive cross match groups. The Dutch Living Donor Kidney Exchange Program has a high transplant rate of 40%, with excellent 5 year graft survival.
authors: Department of Internal Medicine - Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. marry.deklerk@erasmusmc.nl
authors: Marry
authors: M
authors: de Klerk
authors: Judith A
authors: JA
authors: Kal-van Gestel
authors: Bernadette J J M
authors: BJ
authors: Haase-Kromwijk
authors: Frans H J
authors: FH
authors: Claas
authors: Willem
authors: W
authors: Weimar
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001787:Blood Group Incompatibility / Q000276:immunology; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006297:Health Services Accessibility / Q000458:organization & administration*; D006648:Histocompatibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009937:Organizational Objectives; D018579:Patient Selection; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System