Huseynov Amil, Cicek Sevim Nuran Kuslu
Faculty of Medicine, Beykoz University, İstanbul, Turkey.
Medicana Health Group, Transplantation Department, İstanbul, Turkey.
Langenbecks Arch Surg. 2025 Jul 1;410(1):203. doi: 10.1007/s00423-025-03787-5.
Domino kidney paired donation and Two-Way Paired Exchange have emerged as vital strategies to expand the donor pool in renal transplantation, especially for patients facing ABO or HLA incompatibilities. Despite their potential benefits, concerns remain regarding immunological risks, infectious complications, and long-term graft survival.
In this retrospective cohort study conducted at Medicana Transplant Center, 980 adult kidney transplant recipients were categorized into three groups: Domino (n = 144), Two-Way Paired Exchange (n = 350), and Normal Transplant (n = 486). Baseline characteristics, acute rejection rates, and surgical or infectious complications were collected, alongside data on 1-year and 5-year patient and graft survival. Statistical analysis included Kaplan-Meier survival curves and Cox proportional hazards modeling for independent predictors of graft outcomes.
The Domino group had the highest 1-year acute rejection rate (17.4%) compared to Two-Way Paired Exchange (4.3%) and Normal Transplant (3.7%), yet 1-year graft survival rates remained comparable (92%, 95%, and 96%, respectively; p = 0.271). Infectious complications were more frequent in the Domino group (25%) than in others (p < 0.01). Extended follow-up to 5 years indicated no statistically significant difference in overall graft or patient survival among the three groups (log-rank p = 0.197), despite a trend toward lower 5-year graft survival in the Domino group. Donor-specific antibodies and higher HLA mismatches independently predicted acute rejection.
Domino transplantation, while associated with higher immunologic challenges, achieves acceptable short-term and 5-year outcomes akin to Two-Way Paired Exchange and Normal Transplant. Careful immunosuppressive strategies, vigilant monitoring, and collaborative protocols are integral for optimizing long-term success in high-risk transplant scenarios.
多米诺肾配对捐赠和双向配对交换已成为扩大肾移植供体库的重要策略，特别是对于面临ABO或HLA不相容的患者。尽管它们有潜在益处，但免疫风险、感染并发症和长期移植物存活方面仍存在担忧。
在Medicana移植中心进行的这项回顾性队列研究中，980名成年肾移植受者被分为三组：多米诺组（n = 144）、双向配对交换组（n = 350）和正常移植组（n = 486）。收集了基线特征、急性排斥率以及手术或感染并发症的数据，同时收集了1年和5年患者及移植物存活的数据。统计分析包括Kaplan-Meier生存曲线和Cox比例风险模型，用于确定移植物结局的独立预测因素。
与双向配对交换组（4.3%）和正常移植组（3.7%）相比，多米诺组的1年急性排斥率最高（17.4%），但1年移植物存活率仍相当（分别为92%、95%和96%；p = 0.271）。多米诺组的感染并发症比其他组更频繁（25%）（p < 0.01）。延长至5年的随访表明，三组之间的总体移植物或患者存活率无统计学显著差异（对数秩检验p = 0.197），尽管多米诺组的5年移植物存活率有下降趋势。供体特异性抗体和更高的HLA错配独立预测急性排斥。
多米诺移植虽然面临更高的免疫挑战，但能取得与双向配对交换和正常移植相近的可接受的短期和5年结局。谨慎的免疫抑制策略、 vigilant监测和协作方案对于在高风险移植情况下优化长期成功率至关重要。 （注：原文中vigilant可能拼写有误，推测为vigilant，意为警惕的、警觉的）
