Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2016; 4(10): 351-355
Published online Oct 16, 2016. doi: 10.12998/wjcc.v4.i10.351
Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report
Vivek B Kute, Himanshu V Patel, Pankaj R Shah, Pranjal R Modi, Veena R Shah, Sayyed J Rizvi, Bipin C Pal, Manisha P Modi, Priya S Shah, Umesh T Varyani, Pavan S Wakhare, Saiprasad G Shinde, Viajay A Ghodela, Minaxi H Patel, Varsha B Trivedi, Hargovind L Trivedi
Vivek B Kute, Himanshu V Patel, Pankaj R Shah, Priya S Shah, Umesh T Varyani, Pavan S Wakhare, Saiprasad G Shinde, Viajay A Ghodela, Hargovind L Trivedi, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad 380016, India
Pranjal R Modi, Sayyed J Rizvi, Bipin C Pal, Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad 380016, India
Veena R Shah, Manisha P Modi, Department of Anesthesia, IKDRC-ITS, Ahmedabad 380016, India
Minaxi H Patel, Varsha B Trivedi, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, IKDRC-ITS, Ahmedabad 380016, India
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional review board of IKDRC-ITS, Ahmedabad (India).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Vivek B Kute, MD, DM Nephrology (Gold Medalist), FASN, Associate Professor, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Ahmedabad 380016, Gujarat, India. drvivekkute@rediffmail.com
Telephone: +91-79-22687000 Fax: +91-79-22685454
Received: May 1, 2016
Peer-review started: May 3, 2016
First decision: June 17, 2016
Revised: July 11, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: October 16, 2016
Abstract

The combination of kidney paired donation (KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation (LDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful LDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of LDKT.

Keywords: Kidney failure, Chronic, Desensitization, Immunologic, Kidney transplantation, Blood group incompatibility, Living donors, Tissue and organ procurement

Core tip: The combination of desensitization protocol with kidney paired donation (KPD) improves access and outcomes of living donor kidney transplantation, minimizing the limitation of either desensitization protocol or KPD alone. This is useful for sensitized patients who are both difficult to match and desensitize due to panel reactive antigens and strong donor specific antibody.