title: Challenges of kidney paired donation transplants involving multiple donor and recipient surgeons across Australia.
abstract: BACKGROUND
  The Australian kidney paired donation program adopted the principles of within-chain simultaneous live donor surgery and of organ transport, with the requirement of keeping cold ischemia time (CIT) to <12 h. Whether these principles could be adhered to and what impact on transplant outcome they might have is unknown.
  
  
  METHODS
  We evaluated the logistic challenges and outcomes of the first 100 kidney transplants performed in the Australian kidney paired donation program.
  
  
  RESULTS
  Within 4 years, 17 donor surgeons at 12 centres were involved in 37 chain exchange surgeries. Sixteen kidneys were transplanted at the same hospital and 84 required transport to the recipient hospital. Mean (±SD) within chain anaesthetic induction time variability was 8 ± 18 min and mean individual surgeon operating time was 115 ± 44 min. In two cases, delays during donor surgery resulted in increased CIT by 1 h because of deferred transport. CIT was 2.6 ± 0.6 h for non-shipped and 6.8 ± 2.8 h for shipped kidneys, four kidneys had CIT of 12-14 h. Immediate allograft function was observed in 85% of recipients, with no difference between shipped and non-shipped kidneys. There were only two cases of delayed graft function requiring temporary dialysis; both had CIT <7 h. There was no difference in serum creatinine at 1 month between non-shipped and shipped kidneys (105 ± 26 versus 112 ± 50 µmol/L) and allograft survival at 1 year was 97%.
  
  
  CONCLUSIONS
  The study provided a favourable audit of kidney transplant activity, despite challenges of simultaneous surgery, organ transport coordination and prolonged CIT. The decision to ship donor kidneys rather than the donor was demonstrated to be feasible and safe.
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Richard D M
authors.initials: RDM
authors.lastname: Allen
authors.affiliation: Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Henry C C
authors.initials: HCC
authors.lastname: Pleass
authors.affiliation: Department of Nephrology and Transplantation, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Woodroffe
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, University of Adelaide at Central Northern Adelaide Renal and Transplantation Services, Adelaide, South Australia, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: Department of Nephrology and Transplantation, Prince of Wales Hospital, Randwick, New South Wales, Australia.|Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
mesh_terms: D000328:Adult; D001315:Australia; D015331:Cohort Studies; D050377:Cold Ischemia / Q000379:methods*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors / Q000600:supply & distribution*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D055815:Young Adult
keywords: cold ischaemia time; delayed graft function; kidney paired donation; living donor kidney transplantation; organ transport; surgical audit