de Klerk M, Haase-Kromwijk B J J M, Claas F H J, Witvliet M, Weimar W
Department of Internal Medicine-Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Transplant Proc. 2006 Nov;38(9):2793-5. doi: 10.1016/j.transproceed.2006.08.157.
Strategies to decrease the wait time for kidney transplantation include the use of living donor kidneys. However, it is not always possible to donate directly, due to ABO blood type incompatibility or a positive crossmatch. Therefore, other options were explored, including a program for living donor kidney exchange.
All Dutch kidney transplantation centers agreed on a common donor kidney exchange protocol. The Dutch Transplantation Foundation is responsible for the allocation, crossmatches are centrally performed, and exchanges take place on an anonymous basis. Donors travel to the recipient centers. Surgical procedures are simultaneously scheduled.
From January 2004, we registered in total 116 combinations consisting of blood type-incompatible pairs (n = 62) and positive crossmatch pairs (n = 54). In eight match procedures we created 58 new donor-recipient combinations with negative crossmatches, including six triplets and 20 doublets. It proved to be significantly (P = .0014) less difficult to find a solution for the crossmatch-positive combinations than for the blood type-incompatible combinations (67% vs 35%).
The Dutch national living donor kidney exchange program resulted in a 50% success rate. Combining blood type-incompatible and crossmatch-positive donor-recipient pairs in one program is a realistic option for all blood type combinations.
缩短肾移植等待时间的策略包括使用活体供肾。然而，由于ABO血型不相容或交叉配血阳性，并非总是能够直接进行捐献。因此，人们探索了其他选择，包括一个活体供肾交换项目。
所有荷兰肾移植中心就一个通用的供肾交换方案达成一致。荷兰移植基金会负责分配，交叉配血集中进行，交换在匿名的基础上进行。供体前往受者中心。手术程序同时安排。
从2004年1月起，我们总共登记了116组组合，包括血型不相容对（n = 62）和交叉配血阳性对（n = 54）。在8次匹配程序中，我们创建了58组新的交叉配血阴性的供体-受者组合，包括6组三联体和20组双联体。事实证明，为交叉配血阳性组合找到解决方案的难度明显（P = .0014）低于血型不相容组合（67%对35%）。
荷兰全国活体供肾交换项目的成功率为50%。将血型不相容和交叉配血阳性的供体-受者对合并在一个项目中，对于所有血型组合来说都是一个现实的选择。
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