title: Outcomes of paired-exchange live-donor kidney transplantation: a single-center experience.
abstract: BACKGROUND
  Paired-exchange kidney transplantation (PEKT) enables recipients with willing but incompatible donors to find potential matches from a larger pool of donors. It involves transportation of donor kidneys to the intended recipient with a consequent increase in the cold ischemia time (CIT).
  
  
  METHODS
  Our single-center study compared the outcomes of PEKT versus traditional in-center live-donor kidney transplants (ICKT). Retrospective chart review of adult patients who underwent PEKT and ICKT from January 2009 to February 2012 at our institution was performed. Delayed graft function, acute rejection rates, incidence of proteinuria, trends in serum creatinine, and graft and patient survival rates were compared between groups.
  
  
  RESULTS
  Baseline demographic data were similar between the PEKT group (n = 15) and the ICKT group (n = 30) except that CIT (13.1 vs 3.8 hours; P < .001) and panel reactive antibody titers (12.6% ± 22.9% vs 0.9% ± 4.9%; P = .01) were significantly higher in the PEKT group. No patient developed delayed graft function. At a median follow-up of 12.4 months (range: 2-27.5 months), graft and patient survival rates were 100% in both groups. Serial creatinine levels were similar between the groups. There were no significant differences between groups in acute rejection rates (3 of 15 vs 3 of 30) and development of proteinuria posttransplantation (8 of 15 vs 22 of 30).
  
  
  CONCLUSIONS
  Our study found similar outcomes between the PEKT and ICKT groups despite longer CIT and higher panel reactive antibody titers in the PEKT group. These findings support the current practice of PEKT with transporting of donor kidneys, with the resultant increase in the chances of living-donor kidney transplantation.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: A
authors.initials: A
authors.lastname: Bhargava
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: S
authors.initials: S
authors.lastname: Arora
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcus
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania. Electronic address: ksureshk@wpahs.org.
authors.forename: K K
authors.initials: KK
authors.lastname: Sureshkumar
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends