title: Increasing access to renal transplantation in India through our single-center kidney paired donation program: a model for the developing world to prevent commercial transplantation.
abstract: Because access to transplantation with HLA-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end-stage renal disease (ESRD) patient in India. We present a government and institutional ethical review board approved study of 56 ESRD patients [25 two-way and 2 three-way pairs] who consented to participate in KPD transplantation at our center in 2013, performed to avoid blood group incompatibility (n = 52) or positive cross-match (n = 4). All patients had anatomic, functional, and immunologically comparable donors. The waiting time in KPD was short as compared to deceased donor transplantation. Laparoscopic donor nephrectomy was performed in 54 donors. Donor relationships were spousal (n = 40), parental (n = 13), others (n = 3), with median HLA match of 1. Graft survival was 97.5%. Three patients died with functioning graft. 16% had biopsy-proven acute rejection. Mean serum creatinine was 1.2 mg/dl at 0.73 ± 0.32 months follow-up. KPD is a viable, legal, and rapidly growing modality for facilitating LDRT for patients who are incompatible with their healthy, willing living donor. To our knowledge, this is the largest single-center report from India.
authors.affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India.
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kute
authors.forename: Priyadarshini S
authors.initials: PS
authors.lastname: Shah
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Manoj R
authors.initials: MR
authors.lastname: Gumber
authors.forename: Himanshu V
authors.initials: HV
authors.lastname: Patel
authors.forename: Divyesh P
authors.initials: DP
authors.lastname: Engineer
authors.forename: Pankaj R
authors.initials: PR
authors.lastname: Shah
authors.forename: Pranjal R
authors.initials: PR
authors.lastname: Modi
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah
authors.forename: Syed Jamal
authors.initials: SJ
authors.lastname: Rizvi
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003906:Developing Countries; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007194:India; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D012042:Registries; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D055815:Young Adult
keywords: donation; expanded donor pool; kidney clinical; live donors; outcome