Methodist Specialty and Transplant Hospital, San Antonio, TX, USA.
Am J Transplant. 2012 Aug;12(8):2125-32. doi: 10.1111/j.1600-6143.2012.04070.x. Epub 2012 Apr 30.
Many potential kidney transplant recipients are unable to receive a live donor transplant due to crossmatch or blood type incompatibility. Kidney paired donation increases access to live donor transplantation but has been significantly underutilized. We established a kidney paired donation program including consented incompatible donor/recipient pairs as well as compatible pairs with older non-human leukocyte antigen identical donors. Over a 3-year period, a total of 134 paired donor transplants were performed, including 117 incompatible pairs and 17 compatible pairs. All transplants were done with negative flow cytometry crossmatches and five were done with desensitization combined with paired donation. Kidney paired donation transplants included two-way and three-way exchanges as well as three chains initiated by nondirected donors. Of the sensitized recipients transplanted by paired donation, 44% had calculated panel reactive antibody levels greater than 80%. Transplantation of females and prior transplant recipients was significantly higher with paired donation. Only three episodes of rejection occurred and no transplants were lost due to rejection. These data highlight the potential of kidney paired donation and suggest that all transplant centers should be actively engaged in paired donation to increase access to live donor transplantation.
许多潜在的肾移植受者由于配型或血型不合而无法接受活体供者移植。肾配对捐赠增加了活体供者移植的机会，但利用率却显著偏低。我们建立了一个肾配对捐赠计划，包括有意愿的不相容供者/受者配对以及与年龄较大的非人类白细胞抗原相同的供者相匹配的配对。在 3 年的时间里，共进行了 134 例配对供者移植，其中 117 例为不相容配对，17 例为相容配对。所有移植均采用阴性流式细胞术配型，其中 5 例采用脱敏联合配对供者进行。肾配对供者移植包括双向和三向交换，以及由非定向供者发起的三个链。在通过配对供者移植的致敏受者中，44%的计算群体反应性抗体水平大于 80%。配对供者移植中女性和既往移植受者的比例明显更高。仅发生了 3 例排斥反应，没有因排斥反应而丢失移植。这些数据突出了肾配对捐赠的潜力，并表明所有移植中心都应积极参与配对捐赠，以增加活体供者移植的机会。
