Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India.
Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India.
Transpl Int. 2017 Jul;30(7):679-688. doi: 10.1111/tri.12956. Epub 2017 Apr 22.
In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n = 222), positive cross-match (n = 59) and better matching (n = 19). A total of 124 two-way (n = 248), 14 three-way (n = 42), one four-way (n = 4) and one six-way exchange (n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n = 288) and 83.3% (n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist.
在以活体供者肾移植（LDKT）为主导的移植项目中，对于资源有限、肾移植尚处于起步阶段的国家而言，采用配对供肾（KPD）可能是一种增加 LDKT 的经济有效的可行策略。本研究报告了我们在印度采用 KPD 增加 LDKT 的经验，共进行了 300 例单中心 KPD 移植。2000 年 1 月至 2016 年 7 月，我们的移植中心共进行了 3616 例 LDKT 和 561 例 DDKT，其中 300 例（8.3%）采用了 KPD。接受 KPD 的移植患者加入 KPD 的原因是 ABO 不相容（n = 222）、交叉配型阳性（n = 59）和更好的配型（n = 19）。共进行了 124 例双向（n = 248）、14 例三向（n = 42）、1 例四向（n = 4）和 1 例六向（n = 6）交换，共产生 300 例 KPD 移植。死亡风险校正移植物和患者存活率分别为 96%（n = 288）和 83.3%（n = 250）。在 3 ± 3 年的随访中，平均血清肌酐为 1.3mg/dl。我们认为我们的 KPD 项目成功的原因是维持不相容配对的登记、对 KPD 的咨询、大容量的 LDKT 项目和团队合作。KPD 合法、经济有效，并且在没有国家项目的情况下，迅速发展以促进与不相容供者的 LDKT。本研究为不存在国家项目时，通过 KPD 扩展单中心 LDKT 提供了大规模证据。
