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, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India.
Nephrology (Carlton). 2024 Dec;29(12):917-929. doi: 10.1111/nep.14380. Epub 2024 Sep 8.
In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%-35%.
We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT.
Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2-way (n = 2 × 202 = 404), 16.2% 3-way (n = 3 × 29 = 87), 3% 4-way (n = 4 × 4 = 16), 1.8% 5-way (n = 5 × 2 = 10), 2.2% 6-way (n = 6 × 2 = 12), and 1.8% 10-way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow-up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high-volume LDKT programs, non-anonymous allocation and teamwork.
This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs.
在印度，85%的器官捐献来自活体捐献者，15%来自已故捐献者。三分之一的活体捐献者因 ABO 或 HLA 不相容而被拒绝。肾脏交换移植（KET）是一种增加活体供肾移植（LDKT） 25%-35%的具有成本效益和合法的策略。
我们报告了我们在 539 例 KET 病例中的经验，以及我们中心为增加 LDKT 使用而开展的一项单一中心计划的演变情况。
2000 年 1 月至 2024 年 3 月 13 日，我们中心共进行了 1382 例已故供体肾移植和 5346 例 LDKT，其中 10%（n=539）来自 KET。在 539 例 KET 中，80.9%（n=436）为 ABO 不相容对，11.1%（n=60）为相容对，8%（n=43）为致敏对。有 75%（n=2×202=404）为 2 对，16.2%（n=3×29=87）为 3 对，3%（n=4×4=16）为 4 对，1.8%（n=5×2=10）为 5 对，2.2%（n=6×2=12）为 6 对，1.8%（n=10×1=10）为 10 对。受者中 81.2%（n=438）为男性，18.8%（n=101）为女性，而供者中 78.5%（n=423）为女性，21.5%（n=116）为男性。所有供者均为近亲；妻子（54%，n=291）和母亲（20%，n=108）是最常见的供者。中位随访 8.2 年后，患者存活率、死亡风险校正移植物存活率、急性排斥反应和功能移植物的中位血清肌酐水平分别为 81.63%（n=440）、91%（n=494）、9.8%（n=53）和 1.3mg/dL。我们将成功归因于保持不相容对登记册、大容量 LDKT 计划、非匿名分配和团队合作。
这是亚洲最大的单一中心 KET 计划。我们报告了在其他 KET 计划中复制我们成功的挑战和解决方案。
