Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Department of Pediatrics, Medical University Vienna, Vienna, Austria.
Pediatr Transplant. 2024 Sep;28(6):e14840. doi: 10.1111/petr.14840.
Live donor kidney transplantation is considered the optimal choice for renal replacement therapy, providing established benefits, such as superior patient survival and improved quality of life. However, immunological challenges, including ABO blood group incompatibility and, particularly, donor-specific HLA antibodies, may impact long-term outcomes considerably or even prevent safe direct transplantation with the intended donor.
In this review, the authors discuss kidney paired donation (KPD) as a viable strategy to overcome immunological barriers to living donation through organ exchanges. We thereby lay special focus on the Czech-Austrian transnational KPD program.
While the benefits of KPD programs are well established for adult recipients, recent data suggest that this may hold true also for pediatric patients. Complex algorithms, considering factors like the intricate patterns of HLA sensitization, play a pivotal role in predicting suitable matches, but for pediatric patients also non-immunological factors including age and weight match may play a role. As pool size proves crucial for program efficacy, several countries in Europe have now initiated transnational collaborations to maximize match rates. Among those, the Czech-Austrian transnational joint program, established in 2015 and now expanded to a cooperation with the Israel transplant program to further increase transplant rates, represents a successful example.
KPD programs, with their innovative approaches and international partnerships, hold promise for enhancing outcomes and addressing the increasing demand for kidney transplantation.
活体供肾移植被认为是肾替代治疗的最佳选择，具有明显的优势，如患者存活率更高和生活质量改善。然而，免疫方面的挑战，包括 ABO 血型不合，特别是供者特异性 HLA 抗体，可能会对长期结果产生重大影响，甚至可能阻止与预期供者进行安全的直接移植。
在这篇综述中，作者讨论了通过器官交换克服活体捐赠中的免疫障碍的可行策略——即肾对体捐赠（KPD）。我们特别关注捷克-奥地利跨国 KPD 项目。
虽然 KPD 项目对成年受者的益处已得到充分证实，但最近的数据表明，这可能对儿科患者也适用。复杂的算法，考虑到 HLA 致敏的复杂模式等因素，在预测合适的匹配方面起着关键作用，但对于儿科患者，非免疫因素，包括年龄和体重匹配，也可能发挥作用。由于供体池的大小对项目的效果至关重要，欧洲的几个国家现在已经启动了跨国合作，以最大限度地提高匹配率。其中，捷克-奥地利跨国联合项目于 2015 年成立，现与以色列移植项目合作，以进一步提高移植率，这是一个成功的范例。
KPD 项目通过其创新方法和国际合作，有望提高结果，并满足对肾移植日益增长的需求。
