Jha P K, Sethi S, Bansal S B, Jain M, Sharma R, Phanish M K, Duggal R, Ahlawat R, Kher V
Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
Department of Lab Medicine, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Haryana, India.
Indian J Nephrol. 2015 Nov-Dec;25(6):349-54. doi: 10.4103/0971-4065.150721.
In the last decade, paired kidney exchange (PKE) transplantation has gained popularity worldwide as a viable alternative for end stage renal disease (ESRD) patients who have incompatible or sensitized donors. This study presents our experience with PKE transplantation and compares outcome between PKE and non-PKE renal transplant recipients. Between February 2010 and November 2013, 742 transplants were performed, of which 26 (3.5%) were PKE transplantations. All were two-way exchanges. PKE recipients were significantly older than non-PKE (46.73 ± 9.71 vs. 40.08 ± 13.36 years; P = 0.012) while donor ages were comparable. PKE patients had significantly higher number of HLA mismatches (5.03 ± 1.14 vs. 3.49 ± 1.57; P < 0.0001). After a median follow-up of 20 months (range: 3-47 months), there was no significant difference in patient survival (PKE 96.16% vs. non-PKE 96.65%; P = 0.596) and death censored graft survival (PKE 96.16% vs. non-PKE 96.37%; P = 1). Mean serum creatinine at 1 month and at last follow-up was lower in PKE versus non-PKE group (0.98 ± 0.33 vs. 1.3 ± 0.61 mg/dl; P = 0.008 and 0.96 ± 0.30 vs. 1.27 ± 0.57 mg/dl, P = 0.006, respectively). Biopsy proven acute rejection rate was 11.5% in PKE group and 16.89% in non-PKE patients (P = 0.6). To conclude, paired kidney donation is an excellent way of increasing the donor pool and needs to be promoted to overcome the shortage of suitable kidney in our country.
在过去十年中，配对肾脏交换（PKE）移植作为终末期肾病（ESRD）患者的一种可行替代方案，在全球范围内受到欢迎，这些患者的供体不匹配或致敏。本研究介绍了我们在PKE移植方面的经验，并比较了PKE和非PKE肾移植受者的结局。2010年2月至2013年11月期间，共进行了742例移植手术，其中26例（3.5%）为PKE移植。所有均为双向交换。PKE受者的年龄显著大于非PKE受者（46.73±9.71岁对40.08±13.36岁；P=0.012），而供体年龄相当。PKE患者的HLA错配数显著更高（5.03±1.14对3.49±1.57；P<0.0001）。中位随访20个月（范围：3-47个月）后，患者生存率（PKE为96.16%对非PKE为96.65%；P=0.596）和死亡截尾移植物生存率（PKE为96.16%对非PKE为96.37%；P=1）无显著差异。PKE组1个月时和最后随访时的平均血清肌酐低于非PKE组（分别为0.98±0.33对1.3±0.61mg/dl；P=0.008和0.96±0.30对1.27±0.57mg/dl，P=0.006）。活检证实的急性排斥反应率在PKE组为11.5%，在非PKE患者中为16.89%（P=0.6）。总之，配对肾脏捐赠是增加供体库的一种极佳方式，需要在我国推广以克服合适肾脏短缺的问题。
