title: Expanding the Living Donor Pool "Second Act": Laparoscopic Donor Nephrectomy and ABO-Incompatible Kidney Transplantation Improve Donor Recruitment.
abstract: BACKGROUND
  To safely expand our living donor pool, we recently decided to work on 3 areas: analysis of causes of exclusion of potential donors, the results of which we recently published, introduction of laparoscopic donor nephrectomy (LDN), and ABO-incompatible (ABOi) transplantation. We sought to determine the impact of the new strategy on living donor recruitment and transplantation during over a 10-year period at a single institution.
  
  
  METHODS
  From January 2005 to September 2014, we evaluated 131 living donors. Of these, 80 (61%) were genetically related, 51 (39%) unrelated, 119 (91%) ABO compatible (ABOc), 12 ABOi (9%). The analysis was divided into 2 eras: era 1, 2005-2010 (n = 53) included the use of open lumbotomy and acceptance of ABOc only; and era 2, 2011-2014 (n = 78), which saw the introduction of LDN and ABOi transplantation.
  
  
  RESULTS
  Forty-five (34%) potential candidates successfully donated, 67 (51%) were excluded, and 19 (15%) were actively undergoing evaluation. Overall, 53 potential donors were evaluated in era 1 (8.8 donors/year), 78 in era 2 (19.5 donors/year). There were fewer excluded donors in era 2 vs era 1 (62% era 1 vs 44% era 2), and living donor kidney transplantation (LDKT) significantly increased in era 2 vs era 1 (3.3/year era 1 vs 7.1/year era 2). The establishment of an ABOi LDKT program led to a 15% increase of evaluations in era 2 (12/78 donors).
  
  
  CONCLUSIONS
  LDN along with ABOi LDKT allowed for an improvement in recruitment of living donors and corresponding LDKT.
authors.affiliation: Renal Transplant Unit, Rome, Italy. Electronic address: jromagnoli@rm.unicatt.it.
authors.forename: J
authors.initials: J
authors.lastname: Romagnoli
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Salerno
authors.affiliation: Department of Transplantation, Guys Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Mamode
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Calia
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spagnoletti
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Institute of Hematology, Catholic University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Maresca
authors.affiliation: Institute of Hematology, Catholic University, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Piccirillo
authors.affiliation: Institute of Hematology, Catholic University, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Putzulu
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Piselli
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cola
authors.affiliation: Institute of Hematology, Catholic University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zini
authors.affiliation: Renal Transplant Unit, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Citterio
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D000017:ABO Blood-Group System