Huh Kyu Ha, Kim Myoung Soo, Ju Man Ki, Chang Hye Kyung, Ahn Hyung Joon, Lee Su Hyung, Lee Jong Hoon, Kim Soon Il, Kim Yu Seun, Park Kiil
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Transplantation. 2008 Aug 15;86(3):430-5. doi: 10.1097/TP.0b013e3181804a34.
The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce.
From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program.
The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007).
We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients.
供体器官短缺是全球移植领域的主要障碍之一。自1991年韩国直接交换供体（swap）项目取得成功后，我们开展了一个周边交换项目。然而，关于交换供体项目长期结果的报道却很稀少。
从1995年9月至2006年9月，我们进行了1193例肾移植手术，其中包括398例来自非亲属活体供体的手术。非亲属活体供体包括129例交换供体和269例非交换供体。我们比较了交换项目与非交换项目的结果，并探讨了交换项目的优缺点。
进行交换项目的原因包括ABO血型不相容（n = 84，65.1%）、人类白细胞抗原配型超出我们的标准（n = 39，30.2%）或淋巴细胞交叉配型阳性（n = 6，4.7%）。交换移植的总体10年移植肾存活率（86.3%）与非交换移植（82.3%）或单倍型匹配的亲属活体移植（81.2%）相当（P = 0.2994）。在多变量分析中，交换供体与非交换供体对移植肾存活无影响。交换组中O型血供体的比例（29.5%）远低于非交换组（42.4%；P = 0.026）。与非交换组（54.4%；P = 0.007）相比，交换组中O型血肾优先分配给O型血受者（78.9%）。
我们通过使用供体交换项目作为减少供体器官短缺的一种选择取得了优异的结果。然而，交换供体项目对O型血受者没有额外益处。
