Kute Vivek B, Patel Himanshu V, Shah Pankaj R, Modi Pranjal R, Shah Veena R, Kasat Govind S, Patil Mayur V, Patel Jaydeep C, Kumar Deepak P, Trivedi Hargovind L
From the Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
Exp Clin Transplant. 2018 Oct;16(5):528-532. doi: 10.6002/ect.2017.0089. Epub 2017 Sep 26.
This study reports our experience of the first 4-way kidney exchange transplant combined with desensitization in India, which allows increased access to living-donor kidney transplant for sensitized patients.
Four-way kidney exchange transplant procedures were approved by the ethics committee of our institution and the Organ Transplantation Authorization Committee of state governments of India (as per the Transplantation of Human Organs Act of India). The protocols conformed to Declaration of Istanbul principles and the ethical guidelines of the 1975 Helsinki Declaration. Written informed consent was obtained from patients, donors, and their guardians.
In April 2016, our transplant team completed simultaneous 4-way kidney exchange transplant procedures without any medical (rejection and infections) or surgical complications. Reasons for being included for kidney exchange transplant were ABO incom-patible (2 recipients) and sensitization (2 recipients). All 4 recipients had stable graft function with no proteinuria and donor-specific antibody at 11-month follow-up on standard triple immunosup-pression. Patient and graft survival rates were both 100%.
To the best of our knowledge, this is the first single-center report of 4-way kidney exchange transplant combined with desensitization from India. This procedure has the potential to expand living-donor kidney transplant in disadvantaged groups (eg, sensitized patients). Recipients who are hard to match due to high panel reactive antibody and difficult to desensitize due to strong donor-specific antibodies can receive a transplant with a combination of kidney exchange and desensitization. Our study suggests that 4-way kidney exchange transplant can be performed in developing countries (India) similar to that shown in programs in developed countries with team work, kidney exchange registry, and counseling.
本研究报告了我们在印度进行首例四联肾交换移植联合脱敏治疗的经验，该治疗方法使致敏患者有更多机会接受活体供肾移植。
四联肾交换移植手术经我们机构的伦理委员会以及印度邦政府器官移植授权委员会批准（根据《印度人体器官移植法》）。方案符合《伊斯坦布尔宣言》原则和1975年《赫尔辛基宣言》的伦理准则。已获得患者、供体及其监护人的书面知情同意。
2016年4月，我们的移植团队完成了同步四联肾交换移植手术，未出现任何医疗（排斥反应和感染）或手术并发症。纳入肾交换移植的原因是ABO血型不相容（2名受者）和致敏（2名受者）。在标准三联免疫抑制治疗下，所有4名受者在11个月的随访中移植肾功能稳定，无蛋白尿和供体特异性抗体。患者和移植物存活率均为100%。
据我们所知，这是印度首例关于四联肾交换移植联合脱敏治疗的单中心报告。该手术有可能扩大弱势群体（如致敏患者）的活体供肾移植。因高群体反应性抗体难以匹配且因供体特异性抗体强难以脱敏的受者可通过肾交换和脱敏联合治疗接受移植。我们的研究表明，在发展中国家（印度）可以像在发达国家的项目中那样，通过团队协作、肾交换登记和咨询来进行四联肾交换移植。
