de Klerk Marry, Zuidema Willij C, IJzermans Jan N M, Weimar Willem
Department of Internal Medicine - Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam,The Netherlands.
Clin Transpl. 2010:327-32.
Living donor kidney exchange has become an efficient solution for recipients with incompatible donors. Here we describe the fate of all patients that were enrolled in our program during 2004-2010.
Data on registration, computerized matching, cross matching, and transplantations within or outside the program were collected.
Between January 2004 and December 2010, 422 pairs were registered. To create new combinations a match procedure was run 28 times with a median input of 14 (7-22) new pairs and a median of 55 (16-92) participating pairs. Matches were found for 127/185 (69%) cross match-incompatible pairs and 91/237 (38%) ABO-incompatible pairs. 141 of the 218 matched pairs successfully donated and received kidneys in exchange. There were 77 transplants cancelled for medical or psychological reasons, and an alternative solution was found for 26 of these. So in total 167 (141 + 26) patients received a transplant. Of the remaining 51 cancelled transplants, 26 pairs dropped out, 22 patients found an alternative transplantation outside the program and 3 are still waiting. For the 204 unmatched couples, 46 are still in the program while 34 others dropped out, and 124 found an alternative living kidney donor. After 7 years, 39% of participants received a kidney within the exchange program, 35% were transplanted outside the program, 14% of the pairs were delisted and 12% are still waiting. Among the 146 patients who received a kidney outside the program, 47 were transplanted with a deceased donor kidney, 21 found another donor, 37 received an ABO-incompatible transplant and 41 were transplanted in a domino-paired procedure triggered by an non-directed donor.
In the 7 years of our Living Donor Kidney Exchange Program 313/422 (74%) of the participating patients were transplanted. Approximately half of them (167/313, 53%) received a kidney through the exchange program, while 47 (15%) received a deceased donor kidney and 99 (32%) were transplanted through other living donation programs. The exchange program proved to be highly successful not only in its direct results but also indirectly by triggering alternative solutions.
活体供肾交换已成为供体不相容受者的有效解决方案。在此，我们描述了2004年至2010年期间纳入我们项目的所有患者的情况。
收集了关于登记、计算机匹配、交叉配型以及项目内或项目外移植的数据。
2004年1月至2010年12月期间，登记了422对。为了创建新的组合，进行了28次匹配程序，新配对输入中位数为14（7 - 22）对，参与配对中位数为55（16 - 92）对。在185对交叉配型不相容的配对中，有127对（69%）找到了匹配；在237对ABO血型不相容的配对中，有91对（38%）找到了匹配。218对匹配的配对中有141对成功进行了肾脏交换捐赠和接受。有77例移植因医学或心理原因取消，其中26例找到了替代解决方案。所以总共有167例（141 + 26）患者接受了移植。在其余51例取消的移植中，26对退出，22例患者在项目外找到了替代移植，3例仍在等待。对于204例未匹配的夫妇，46例仍在项目中，34例退出，124例找到了替代活体供肾者。7年后，39%的参与者在交换项目中接受了肾脏移植，35%在项目外进行了移植，14%的配对被除名，12%仍在等待。在146例在项目外接受肾脏移植的患者中，47例接受了尸体供肾移植，21例找到了另一个供体，37例接受了ABO血型不相容移植，41例通过非定向供体触发的多米诺配对程序进行了移植。
在我们的活体供肾交换项目的7年中，313/422（74%）的参与患者接受了移植。其中约一半（167/313，53%）通过交换项目接受了肾脏，47例（15%）接受了尸体供肾，99例（32%）通过其他活体捐赠项目进行了移植。交换项目不仅在直接结果上，而且在触发替代解决方案方面都被证明是非常成功的。
