title: Paired kidney exchange transplantation: Maximizing the donor pool.
abstract: In the last decade, paired kidney exchange (PKE) transplantation has gained popularity worldwide as a viable alternative for end stage renal disease (ESRD) patients who have incompatible or sensitized donors. This study presents our experience with PKE transplantation and compares outcome between PKE and non-PKE renal transplant recipients. Between February 2010 and November 2013, 742 transplants were performed, of which 26 (3.5%) were PKE transplantations. All were two-way exchanges. PKE recipients were significantly older than non-PKE (46.73 ± 9.71 vs. 40.08 ± 13.36 years; P = 0.012) while donor ages were comparable. PKE patients had significantly higher number of HLA mismatches (5.03 ± 1.14 vs. 3.49 ± 1.57; P < 0.0001). After a median follow-up of 20 months (range: 3-47 months), there was no significant difference in patient survival (PKE 96.16% vs. non-PKE 96.65%; P = 0.596) and death censored graft survival (PKE 96.16% vs. non-PKE 96.37%; P = 1). Mean serum creatinine at 1 month and at last follow-up was lower in PKE versus non-PKE group (0.98 ± 0.33 vs. 1.3 ± 0.61 mg/dl; P = 0.008 and 0.96 ± 0.30 vs. 1.27 ± 0.57 mg/dl, P = 0.006, respectively). Biopsy proven acute rejection rate was 11.5% in PKE group and 16.89% in non-PKE patients (P = 0.6). To conclude, paired kidney donation is an excellent way of increasing the donor pool and needs to be promoted to overcome the shortage of suitable kidney in our country.
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Jha
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: S
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Bansal
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: M
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Phanish
authors.affiliation: Department of Lab Medicine, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Duggal
authors.affiliation: Department of Urology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: R
authors.initials: R
authors.lastname: Ahlawat
authors.affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: V
authors.initials: V
authors.lastname: Kher
keywords: Developing world; India; kidney transplant; paired kidney exchange