Ahn B K, Kwon O J, Kang C M
Transplantation Center, Hanyang University Hospital, Seoul, Korea.
Transplant Proc. 2012 Jan;44(1):17-21. doi: 10.1016/j.transproceed.2011.12.022.
The exchange donor program in renal transplantation is an efficient solution for recipients with a blood type or crossmatch-incompatible donor. However, this program has some difficulties to define unacceptable human leukocyte antigen matches, deteriorating clinical potential recipient condition, and withdrawal of donor consent. We analyzed the outcomes of exchange donor renal transplantation through the altruistic unbalanced chain.
Among 152 cases of exchange donor renal transplantation from 1991 to 2010 in our hospital, we performed 58 procedures through altruistic unbalanced chains. We compared their outcomes with the direct and balanced chain group. We analyzed retrospectively whether this program expanded the donor pool, seeking better immunologic, size, and age matching.
The graft survival and acute rejection rates did not differ significantly in the two groups. Of 152 cases, 58 (38.2%) renal transplantations were performed through an unbalanced chain. Seventeen waiting list recipients were transplanted through an altruistic unbalanced chain. In blood type O recipients (n = 32), the causes of registration in the exchange program were ABO incompatibility (93.3%), and positive crossmatch (6.7%). Nine altruistic blood type O donors and 9 (28.1%) type O recipients underwent transplantations through this chain.
We suggest the altruistic unbalanced chain may expand the donor pool with advantages for difficult-to-match pairs. The disadvantages of type O recipients may be overcome through the use of an unbalanced chain. The altruistic unbalanced exchange transplantation program can help easy-to-match subjects, shortening the waiting periods.
肾移植中的交换供体项目是解决血型或交叉配型不相合供体受者的有效方案。然而，该项目在定义不可接受的人类白细胞抗原配型、临床潜在受者病情恶化以及供体撤销同意方面存在一些困难。我们通过利他性不平衡链分析了交换供体肾移植的结果。
在我院1991年至2010年的152例交换供体肾移植病例中，我们通过利他性不平衡链进行了58例手术。我们将其结果与直接和平衡链组进行了比较。我们回顾性分析了该项目是否扩大了供体库，寻求更好的免疫、大小和年龄匹配。
两组的移植物存活率和急性排斥率无显著差异。在152例病例中，58例（38.2%）肾移植是通过不平衡链进行的。17名等待名单上的受者通过利他性不平衡链进行了移植。在O型血受者（n = 32）中，参与交换项目登记的原因是ABO不相容（93.3%）和交叉配型阳性（6.7%）。9名利他性O型血供体和9名（28.1%）O型血受者通过该链进行了移植。
我们认为利他性不平衡链可能会扩大供体库，对难以匹配的配对具有优势。通过使用不平衡链可以克服O型血受者的劣势。利他性不平衡交换移植项目可以帮助易于匹配的受试者，缩短等待时间。
