title: Four years of experience with the Australian kidney paired donation programme.
abstract: New approaches to increase kidney transplantation rates through expansion of live donor kidney transplantation have become necessary due to ongoing shortage of deceased donor organs. These strategies include desensitization in antibody-incompatible transplants to overcome the barrier of blood group incompatibility or human leucocyte antigen antibodies between recipient and donor and kidney paired donation (KPD) programmes. In KPD, a kidney transplant candidate with an incompatible live donor joins a registry of other incompatible pairs in order to find potentially compatible transplant solutions. To match the largest possible number of donor-recipient pairs while minimizing immunologic risk, KPD programmes use sophisticated algorithms to identify suitable matches with simultaneous two-way or more complex multi-way exchanges as well as including non-directed anonymous donors to start a chain of compatible transplantations. Because of the significant immunologic barriers when fewer donor options are available, the optimal solution for difficult-to-match, highly sensitized patients is access to more potential donors using large multi-centre or national KPD registries. This review focuses on the first 4 years of experience with the Australian multi-centre KPD programme that was established in October 2010.
authors.affiliation: Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Cantwell
authors.forename: Claudia
authors.initials: C
authors.lastname: Woodroffe
authors.forename: Rhonda
authors.initials: R
authors.lastname: Holdsworth
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D046148:Donor Selection / Q000458:organization & administration*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006297:Health Services Accessibility / Q000458:organization & administration*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors / Q000600:supply & distribution*; D011237:Predictive Value of Tests; D016730:Program Development; D015397:Program Evaluation; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome
keywords: HLA incompatibility; altruistic donation; blood group incompatibility; kidney paired donation; living donor kidney transplantation