Huseynov Amil, Kuşlu Çicek Sevim Nuran, Tuncer Murat
Medicine, Beykoz University, Istanbul 34180, Türkiye.
Department of Transplantation, Medicana International Istanbul, Istanbul 34180, Türkiye.
World J Clin Cases. 2025 Jun 6;13(16):102740. doi: 10.12998/wjcc.v13.i16.102740.
Kidney transplantation is one of the most effective treatments for patients with end-stage renal disease. However, many regions face low deceased donor rates and limited ABO-compatible transplant availability, which increases reliance on living donors. These regional challenges necessitate the implementation of kidney paired donation (KPD) programs to overcome incompatibilities such as ABO mismatch or positive cross-matching, even when suitable and willing donors are available.
To evaluate the effectiveness of a single-center domino KPD model in both operational planning and clinical management processes and to assess its impact on clinical outcomes.
Between April 2020 and January 2024, we retrospectively evaluated patients enrolled in our center's domino kidney transplantation program. Donor-recipient pairs unable to proceed due to ABO incompatibility or positive cross-matching with their own living donors were included. Donors and recipients were assessed based on blood group compatibility, HLA tissue typing, and negative cross-match results. A specialized computer algorithm grouped patients into three-way, four-way, and five-way chains. All surgical procedures were performed on the same day at a single center.
A total of 169 kidney transplants were performed, forming 52 domino chains. These domino KPD transplants accounted for a notable proportion of our center's overall transplant activity, which included both living donor kidney transplants and deceased donor transplants. Among these chains, the primary reasons for participation were ABO incompatibility (74%), positive cross-matching (10%), and the desire to improve HLA mismatch (16%). Improved HLA mismatch profiles and high graft survival (96% at 1 year, 92% at 3 years) and patient survival (98% at 1 year, 94% at 3 years) rates were observed, as well as low acute rejection episodes.
The single-center domino KPD model enhanced transplant opportunities for incompatible donor-recipient pairs while maintaining excellent clinical outcomes. By providing a framework that addresses regional challenges, improves operational efficiency, and optimizes clinical management, this model offers actionable insights to reduce waiting lists and improve patient outcomes.
肾移植是终末期肾病患者最有效的治疗方法之一。然而，许多地区面临着低尸体供体率和有限的 ABO 血型相容移植可用性的问题，这增加了对活体供体的依赖。这些地区性挑战使得有必要实施肾配对捐赠（KPD）计划，以克服诸如 ABO 血型不匹配或阳性交叉配型等不相容性，即使有合适且愿意捐赠的供体。
评估单中心多米诺 KPD 模型在运营规划和临床管理过程中的有效性，并评估其对临床结果的影响。
在 2020 年 4 月至 2024 年 1 月期间，我们回顾性评估了参与本中心多米诺肾移植计划的患者。纳入因 ABO 血型不相容或与其自身活体供体阳性交叉配型而无法进行移植的供体 - 受体对。根据血型相容性、HLA 组织分型和阴性交叉配型结果对供体和受体进行评估。一种专门的计算机算法将患者分组为三联、四联和五联链。所有手术均在同一天于单一中心进行。
共进行了 169 例肾移植，形成了 52 条多米诺链。这些多米诺 KPD 移植在本中心的整体移植活动中占显著比例，本中心的整体移植活动包括活体供肾移植和尸体供肾移植。在这些链中，参与的主要原因是 ABO 血型不相容（74%）、阳性交叉配型（10%）以及改善 HLA 错配的愿望（16%）。观察到 HLA 错配情况得到改善，移植肾存活率高（1 年时为 96%，3 年时为 92%），患者存活率高（1 年时为 98%，3 年时为 94%），且急性排斥反应发生率低。
单中心多米诺 KPD 模型增加了不相容供体 - 受体对的移植机会，同时保持了良好的临床结果。通过提供一个应对地区性挑战、提高运营效率和优化临床管理的框架，该模型为减少等待名单和改善患者结局提供了可操作的见解。
