Kute Vivek B, Vanikar Aruna V, Shah Pankaj R, Gumber Manoj R, Patel Himanshu V, Engineer Divyesh P, Modi Pranjal R, Shah Veena R, Trivedi Hargovind L
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India.
Nephrology (Carlton). 2014 Oct;19(10):599-604. doi: 10.1111/nep.12307.
According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy.
根据印度慢性肾脏病登记处的数据，2010年仅有2%的终末期肾病患者接受了肾移植治疗，37%接受了透析治疗，61%接受了非肾脏替代治疗的保守治疗。在像印度这样没有完善的尸体供肾移植项目的国家，活体供肾移植是肾移植的主要器官来源。拒绝定向活体捐赠供体的最常见原因是ABO血型不相容，这使得多达三分之一的潜在活体供体库被排除。由于采用人类白细胞抗原（HLA）脱敏方案和ABO血型不相容移植进行移植的机会非常有限，原因是成本高昂且强化免疫抑制带来的感染风险增加，肾脏配对捐赠（KPD）给越来越多的终末期肾病患者带来了希望。KPD是一种快速发展且具有成本效益的活体供肾移植策略，适用于与健康、愿意捐赠的活体供体不相容的患者。原则上，任何进行活体供肾移植的中心都可行KPD。在拥有大型活体供肾移植项目的移植中心，KPD不需要额外的基础设施，可减少等待时间，避免移植旅游并防止商业交易。尽管KPD在印度的应用仍然不足，但近年来其实施频率有所增加。为了大幅增加供体库和移植率，移植中心应共同努力建立一个全国性的KPD项目，并制定统一的可接受分配政策。
