de Klerk Marry, Zuidema Willij C, Ijzermans Jan N M, Weimar Willem
Dept of Internal Medicine - Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Clin Transpl. 2009:247-52.
Kidney transplantations with living related and unrelated donors are the optimal option for patients with end-stage renal disease. For patients with a willing--but blood-type or HLA incompatible donor--a living-donor kidney exchange program could be an opportunity. In Asia, the United States and Europe, kidney exchange programs were developed under different conditions, with different exchange algorithms, and with different match results. The easiest way to organize a living-donor kidney exchange program is to enlist national or regional cooperation, initiated by an independent organization that is already responsible for the allocation of deceased donor organs. For logistic reasons, the optimal maximum chain length should be three pairs. To optimize cross-match procedures a central laboratory is recommended. Anonymity between the matched pairs depends on the culture and logistics of the various countries. For incompatible donor-recipient pairs who have been unsuccessful in finding suitable matches in an exchange program, domino-paired kidney transplantations triggered by Good Samaritan donors is the next alternative. To expand transplantations with living donors, we advise integrating such a program into a national exchange program under supervision of an independent allocation authority. If no Good Samaritan donors are available, an unbalanced kidney paired-exchange program with compatible and incompatible pairs is another strategy that merits future development.
亲属活体供肾和非亲属活体供肾肾移植是终末期肾病患者的最佳选择。对于有意愿但血型或人类白细胞抗原（HLA）不相合的供者的患者，活体供肾交换项目可能是一个机会。在亚洲、美国和欧洲，肾交换项目在不同条件下开展，采用不同的交换算法，取得了不同的匹配结果。组织活体供肾交换项目最简单的方法是寻求国家或地区层面的合作，由一个已经负责分配 deceased donor 器官的独立组织发起。出于后勤方面的原因，最佳的最大链条长度应为三对。为优化交叉配型程序，建议设立一个中央实验室。匹配对之间的匿名性取决于各国的文化和后勤情况。对于在交换项目中未能找到合适匹配的不相合供受者对，由好心的供者引发的多米诺配对肾移植是下一个选择。为扩大活体供肾移植，我们建议在一个独立分配机构的监督下，将这样一个项目纳入国家交换项目。如果没有好心的供者，一个包含相合和不相合对的非平衡肾配对交换项目是另一个值得未来发展的策略。
