Kute Vivek B, Prasad Narayan, Shah Pankaj R, Modi Pranjal R
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India.
Department of Nephrology and Clinical Transplantation, SGPGI, Lucknow 226014, India.
World J Transplant. 2018 Jun 28;8(3):52-60. doi: 10.5500/wjt.v8.i3.52.
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, -way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel kidney transport and anonymity non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver kidney exchange, a legitimate hope or utopia?
肾交换移植是增加活体供肾移植的成熟方式。加入肾交换项目的原因包括ABO血型不相容、免疫不相容（阳性交叉配型或供者特异性抗体）、人类白细胞抗原（HLA）不相容（HLA配型不佳）、时间不相容和经济不相容。肾交换移植已从传统的同时进行的匿名双向肾交换发展到更复杂的方式，如三方交换、四方交换、多方交换、相容对、非同时肾交换、非同时扩大利他供者、无尽利他供者、肾交换联合脱敏、肾交换联合ABO不相容肾移植、可接受的错配移植、使用A2供者给O型受者、活体供者 - deceased供者名单交换、多米诺链、非匿名肾交换、单中心、多中心、区域、国家、国际和全球肾交换。在此，我们讨论肾交换的最新进展，如全球环境下的国际肾交换移植、三类先进捐赠项目、 deceased供者作为链式起始肾的来源、供者反悔的神话或现实、发达国家匿名的利弊以及发展中国家（非）匿名的利弊、供者出行肾运输的利弊、不相容供受者对的管理算法以及全球肾交换的利弊。参与的移植团队和供受者对应根据当地资源和后勤情况，就肾供者出行肾运输以及分配中的匿名与否达成共识并做出决定。资源有限环境下器官移植的未来会是肝肾交换，是合理的希望还是乌托邦？
