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Kute VB, Patel HV, Banerjee S, Aziz F, Godara SM, Bansal SB, Bhalla AK, Modi P, Sharma A, Billa V, Narayanan S, Ranjan P, Singla M, Soin AS, Gupta S, Guleria S, Bhangui P, Gupta A, Ray DS, Engineer DP, Rizvi J, Parmar V, Bahadur MM, Singh S, Shingare AP, Shah BV, Hafeeq B, Aboobacker IN, Barnela S, Chauhan M, Varughese S, Khullar D, Rela M, Kothari J, Bichu S, Kumar D, Das P, Gopinathan JC, Eapen JJ, Das SS, Prakash S, Kumar BT A, Ambike S, Angral R, Saxena S, Bavikar S, Tripathi V, Srinivasa S, Hegde U, Siddini V, Mohanty N, Mammen KJ, Abraham M A, Bajpai D, Chauhan S, Kumar A, Balwani MR, Meshram HS, Mohanka R, Sudhindran S, Chaubal G, Srinivasan T, Rammohan A, Mishra V, Thukral S, Bavikar P, Jamale T, Kriplani J, Girish N, Parikh K, Jeloka T, Sreekumar V, Aslam S, Guptha V, Agarwal D, Gulati S, Gupta A, Kiran MK, Anandh U, Gumber M, Chowdhary PK, Khetan P, Nayak K, Deshpande R, Godhani U, Pattewar S, Mehta K, Inamdar N, Yadav RK, Shrimali J, Goswami J, Garsa R, Balasubramaniyam R, Mukkavilli KK, Sharma RK, Soni S, Wani I, Kakde S, Prasad N, Singh G, et alKute VB, Patel HV, Banerjee S, Aziz F, Godara SM, Bansal SB, Bhalla AK, Modi P, Sharma A, Billa V, Narayanan S, Ranjan P, Singla M, Soin AS, Gupta S, Guleria S, Bhangui P, Gupta A, Ray DS, Engineer DP, Rizvi J, Parmar V, Bahadur MM, Singh S, Shingare AP, Shah BV, Hafeeq B, Aboobacker IN, Barnela S, Chauhan M, Varughese S, Khullar D, Rela M, Kothari J, Bichu S, Kumar D, Das P, Gopinathan JC, Eapen JJ, Das SS, Prakash S, Kumar BT A, Ambike S, Angral R, Saxena S, Bavikar S, Tripathi V, Srinivasa S, Hegde U, Siddini V, Mohanty N, Mammen KJ, Abraham M A, Bajpai D, Chauhan S, Kumar A, Balwani MR, Meshram HS, Mohanka R, Sudhindran S, Chaubal G, Srinivasan T, Rammohan A, Mishra V, Thukral S, Bavikar P, Jamale T, Kriplani J, Girish N, Parikh K, Jeloka T, Sreekumar V, Aslam S, Guptha V, Agarwal D, Gulati S, Gupta A, Kiran MK, Anandh U, Gumber M, Chowdhary PK, Khetan P, Nayak K, Deshpande R, Godhani U, Pattewar S, Mehta K, Inamdar N, Yadav RK, Shrimali J, Goswami J, Garsa R, Balasubramaniyam R, Mukkavilli KK, Sharma RK, Soni S, Wani I, Kakde S, Prasad N, Singh G, Soni R, Shankar A, Gireesh M, Srivastava A. Analysis of kidney and liver exchange transplantation in India (2000–2025): a multicentre, retrospective cohort study. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2025; 37:100597. [DOI: 10.1016/j.lansea.2025.100597] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2025]
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Dinckan A, Eren E, Ensaroglu F, Sahin T, Parlak H, Kocyigit A, Alkara U, Akyildiz M, Tokac M. Paired Exchange Living Donor Liver Transplantation: A Single Center Experience From Turkiye. Transplant Proc 2025; 57:272-276. [PMID: 39648064 DOI: 10.1016/j.transproceed.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 11/11/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND In countries with low rates of deceased donor solid organ transplantations, live-donor liver transplantation is the preferred definitive treatment for children and adults with end-stage liver disease. However, it is known that a remarkable number of potential living liver donors are rejected due to ABO incompatibility, suboptimal liver mass, or anatomical features. Paired exchange liver transplantation (PELT) practice emerged to overcome these obstacles. Herein, we present the results of our single-center experience with PELT and compare them with previously reported data. METHODS Patients who underwent PELT between January 2015 and December 2022 constituted the target population. The collected recipient data included demographic parameters, the model for end-stage liver disease score, graft-recipient weight ratio, indication for LT and paired exchange, body-mass index, duration of hospital stay, duration of intensive care unit stay, postoperative complications and inpatient mortality. Donor data, including demographic characteristics, body mass index, type of liver graft (right lobe or left lateral segment), graft weight (g), type of portal vein anatomy (Type 1, 2, or 3), type of biliary anatomy (Type 1, 2, 3a, 3b), duration of hospital stay, complications and mortality were retrieved. RESULTS Among 18 recipients, 14 (78%) were male, and 4 (22%) were female. The mean recipient age was 50.7 [2-66], while the mean donor age was 29.3 [18-40]. The mean follow-up period was 31.9 [12-71] months. The 1-year patient and graft survivals were calculated as 83.3% and 88.9%. CONCLUSION The PELT can be utterly feasible at transplant centers with remarkable LDLT experience.
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Affiliation(s)
- Ayhan Dinckan
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Eryigit Eren
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Fatih Ensaroglu
- Department of Gastroenterology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Taylan Sahin
- Department of Anesthesiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Hakan Parlak
- Department of Anesthesiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocyigit
- Department of Radiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Utku Alkara
- Department of Radiology, Yeni Yuzyil Training and Research Hospital, Istanbul, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University, School of Medicine, Istanbul, Turkey
| | - Mehmet Tokac
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey.
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Klair T, Fritze D, Halff G, Patnaik R, Thomas E, Abrahamian G, Cullen JM, Cigarroa F. Liver paired exchange: A US single-center experience-Pairs, chains, and use of compatible pairs. Liver Transpl 2024; 30:1013-1025. [PMID: 38727617 DOI: 10.1097/lvt.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/01/2024] [Indexed: 09/13/2024]
Abstract
In the United States, the discrepancy between organ availability and need has persisted despite changes in allocation, innovations in preservation, and policy initiatives. Living donor liver transplant remains an underutilized means of improving access to timely liver transplantation and decreasing waitlist mortality. Liver paired exchange (LPE) represents an opportunity to overcome living donor liver transplant pair incompatibility due to size, anatomy, or blood type. LPE was adopted as a strategy to augment access to liver transplantation at our institution. Specific educational materials, consent forms, and selection processes were developed to facilitate LPE. From 2019 through October 2023, our center performed 11 LPEs, resulting in 23 living donor liver transplant pairs. The series included several types of LPE: those combining complementary incompatible pairs, the inclusion of compatible pairs to overcome incompatibility, and the use of altruistic nondirected donors to initiate chains. These exchanges facilitated transplantation for 23 recipients, including 1 pediatric patient. LPE improved access to liver transplantation at our institution. The ethical application of LPE includes tailored patient education, assessment and disclosure of exchange balance, mitigation of risk, and maximization of benefit for donors and recipients.
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Affiliation(s)
- Tarunjeet Klair
- Malu & Carlos Alvarez Center for Transplantation, Hepatobiliary Surgery and Innovation University of Texas Health San Antonio, San Antonio, Texas, USA
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Al-Thnaibat MH, Balaw MK, Al-Aquily MK, Ghannam RA, Mohd OB, Alabidi F, Alabidi S, Hussein F, Rawashdeh B. Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan. J Transplant 2024; 2024:4538034. [PMID: 38577225 PMCID: PMC10994704 DOI: 10.1155/2024/4538034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in living donor transplantation, Jordan's organ donation after brain death program remains inactive, making it challenging to meet organ demand and placing many patients on long transplant waiting lists. As of 2020, only 14.2% of the patients with end-stage kidney disease have access to a living donor. The scarcity of compatible living donors exacerbates Jordan's organ shortage, leaving patients with extended waits and uncertain transplant prospects. Due to the lack of living donors and the inactive brain death donation program, additional options are needed to meet organ demand. Kidney paired exchange (KPE), emerges as a potential solution to the problem of donor shortage and donor-recipient incompatibility. By allowing living donors to direct their donated organs to different compatible recipients, KPE offers the promise of expanding transplant opportunities for patients without suitable living donors. However, the current Jordanian law restricting living kidney donation to fifth-degree relatives further limits the pool of potential donors, aggravating the organ shortage situation. This article explores the feasibility of implementing KPE in Jordan and proposes an approach to implementing KPE in Jordan, considering ethical and legal aspects to substantially increase kidney transplants.
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Affiliation(s)
- Mohammad H. Al-Thnaibat
- Department of Internal Medicine, Faculty of Medicine, Hashemite University, Zarqa 13133, Jordan
| | | | | | - Reem A. Ghannam
- College of Medicine, Hashemite University, Zarqa 13133, Jordan
| | - Omar B. Mohd
- College of Medicine, Hashemite University, Zarqa 13133, Jordan
| | - Firas Alabidi
- Jordan University of Science and Technology, Irbid, Jordan
| | | | - Fadi Hussein
- Department of Nephrology, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Badi Rawashdeh
- Medical College of Wisconsin, Division of Transplant Surgery, Milwaukee, Wisconsin, USA
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Altun E, Yavuz M. Long-Term Outcomes of Kidney Paired Donation Transplantation: A Single Center Retrospective Cohort Study. Transplant Proc 2023; 55:325-331. [PMID: 36890053 DOI: 10.1016/j.transproceed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND This study aimed to compare the kidney paired donation (KPD) program recipients with the traditional living donor kidney transplantation (LDKT) recipients regarding patient and graft survival. METHODS We retrospectively analyzed 141 recipients of the KPD program and 141 classic LDKT recipients that we matched for age and sex as controls between July 2005 and June 2019. We compared the 2 transplant groups for patient and kidney survival using the Kaplan-Maier test. We also performed Cox Regression analysis to examine factors affecting patient survival, including transplant type. RESULTS The average follow-up period was 96.17 ± 44.22 months. Of the 282 patients, 88 died in the follow-up period. There was no statistically significant difference in graft and patient survival between the KPD and LDKT groups. In the Cox regression model, including the transplant type, only the serum creatinine level measured in the first month after discharge was a significant factor in predicting patient survival. CONCLUSIONS The findings of this study indicate that the KPD program is an effective and reliable method to increase LDKT. Country-wide multicentric studies should confirm the results of this study. In countries where cadaver transplantation is insufficient, efforts should be made to expand the KPD program.
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Affiliation(s)
- Eda Altun
- Bahcesehir University Faculty of Medicine, Department of Nephrology, Goztepe Medicalpark Hospital, Istanbul, Turkey.
| | - Melike Yavuz
- Bahcesehir University Faculty of Medicine, Department of Public Health, Istanbul
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Mamode N, Bestard O, Claas F, Furian L, Griffin S, Legendre C, Pengel L, Naesens M. European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group. Transpl Int 2022; 35:10511. [PMID: 36033645 PMCID: PMC9399356 DOI: 10.3389/ti.2022.10511] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022]
Abstract
This guideline, from a European Society of Organ Transplantation (ESOT) working group, concerns the management of kidney transplant patients with HLA antibodies. Sensitization should be defined using a virtual parameter such as calculated Reaction Frequency (cRF), which assesses HLA antibodies derived from the actual organ donor population. Highly sensitized patients should be prioritized in kidney allocation schemes and linking allocation schemes may increase opportunities. The use of the ENGAGE 5 ((Bestard et al., Transpl Int, 2021, 34: 1005–1018) system and online calculators for assessing risk is recommended. The Eurotransplant Acceptable Mismatch program should be extended. If strategies for finding a compatible kidney are very unlikely to yield a transplant, desensitization may be considered and should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Few studies compare HLA incompatible transplantation with remaining on the waiting list, and comparisons of morbidity or quality of life do not exist. Kidney paired exchange programs (KEP) should be more widely used and should include unspecified and deceased donors, as well as compatible living donor pairs. The use of a KEP is preferred to desensitization, but highly sensitized patients should not be left on a KEP list indefinitely if the option of a direct incompatible transplant exists.
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Affiliation(s)
- Nizam Mamode
- Department of Transplantation, Guys Hospital, London, United Kingdom
- *Correspondence: Nizam Mamode,
| | - Oriol Bestard
- Department of Nephrology and Kidney Transplantation, Vall d’Hebrón University Hospital, Barcelona, Spain
| | - Frans Claas
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
- Department of Immunology, University of Antwerp, Antwerp, Belgium
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, University Hospital of Padua, Padua, Italy
| | - Siân Griffin
- Department of Nephrology, University Hospital of Wales, Cardiff, United Kingdom
| | - Christophe Legendre
- Department of Nephrology and Adult Kidney Transplantation, Hôpital Necker and Université de Paris, Paris, France
| | - Liset Pengel
- Centre for Evidence in Transplantation, University of Oxford, Oxford, United Kingdom
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Wang W, Leichtman AB, Rees MA, Song PXK, Ashby VB, Shearon T, Kalbfleisch JD. Kidney Paired Donation Chains Initiated by Deceased Donors. Kidney Int Rep 2022; 7:1278-1288. [PMID: 35685310 PMCID: PMC9171627 DOI: 10.1016/j.ekir.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Rather than generating 1 transplant by directly donating to a candidate on the waitlist, deceased donors (DDs) could achieve additional transplants by donating to a candidate in a kidney paired donation (KPD) pool, thereby, initiating a chain that ends with a living donor (LD) donating to a candidate on the waitlist. We model outcomes arising from various strategies that allow DDs to initiate KPD chains. Methods We base simulations on actual 2016 to 2017 US DD and waitlist data and use simulated KPD pools to model DD-initiated KPD chains. We also consider methods to assess and overcome the primary criticism of this approach, namely the potential to disadvantage blood type O-waitlisted candidates. Results Compared with shorter DD-initiated KPD chains, longer chains increase the number of KPD transplants by up to 5% and reduce the number of DDs allocated to the KPD pool by 25%. These strategies increase the overall number of blood type O transplants and make LDs available to candidates on the waitlist. Restricting allocation of blood type O DDs to require ending KPD chains with LD blood type O donations to the waitlist markedly reduces the number of KPD transplants achieved. Conclusion Allocating fewer than 3% of DD to initiate KPD chains could increase the number of kidney transplants by up to 290 annually. Such use of DDs allows additional transplantation of highly sensitized and blood type O KPD candidates. Collectively, patients of each blood type, including blood type O, would benefit from the proposed strategies.
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Abstract
BACKGROUND Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US. STUDY DESIGN This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE. RESULTS A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months). CONCLUSIONS LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.
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Bastos J, Machado DJDB, David-Neto E. Increasing transplantability in Brazil: time to discuss Kidney Paired Donation. J Bras Nefrol 2021; 44:417-422. [PMID: 35107119 PMCID: PMC9518625 DOI: 10.1590/2175-8239-jbn-2021-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction: Kidney transplantation (KT) is the best treatment for chronic kidney disease. In Brazil, there are currently more than 26 thousand patients on the waitlist. Kidney Paired Donation (KPD) offers an incompatible donor-recipient pair the possibility to exchange with another pair in the same situation, it is a strategy to raise the number of KT. Discussion: KPD ceased being merely an idea over 20 years ago. It currently accounts for 16.2% of living donors KT (LDKT) in the USA and 8% in Europe. The results are similar to other LDKT. It is a promising alternative especially for highly sensitized recipients, who tend to accumulate on the waitlist. KPD is not limited to developed countries, as excellent results were already published in India in 2014. In Guatemala, the first LDKT through KPD was performed in 2011. However, the practice remains limited to isolated cases in Latin America. Conclusion: KPD programs with different dimensions, acceptance rules and allocation criteria are being developed and expanded worldwide to meet the demands of patients. The rise in transplantability brought about by KPD mostly meets the needs of highly sensitized patients. The Brazilian transplant program is mature enough to accept the challenge of starting its KPD program, intended primarily to benefit patients who have a low probability of receiving a transplant from a deceased donor.
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Affiliation(s)
- Juliana Bastos
- Santa Casa de Misericórdia de Juiz de Fora, Departamento de Transplante, Juiz de Fora, MG, Brasil
| | | | - Elias David-Neto
- Hospital das Clínicas da Universidade de São Paulo, Departamento de Transplante, São Paulo, SP, Brasil
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Pines R, Iraheta YA, Dahmani KA, Cooper M, Waterman AD. Understanding Patients' and Living Donors' Kidney Paired Donation Educational Experiences and Recommendations for Improvement. Prog Transplant 2021; 32:19-26. [PMID: 34894855 DOI: 10.1177/15269248211064878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients' and donors' decision-making about donation, the educational content they received, and their recommendations for educational improvements. METHOD We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). FINDINGS Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators' helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. DISCUSSION Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making.
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Affiliation(s)
- Rachyl Pines
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Yaquelin Arevalo Iraheta
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katia A Dahmani
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Center for Transplantation, 23534Houston Methodist Hospital, Houston, Texas, USA
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Kaplan A, Rosenblatt R, Samstein B, Brown RS. Can Living Donor Liver Transplantation in the United States Reach Its Potential? Liver Transpl 2021; 27:1644-1652. [PMID: 34174025 DOI: 10.1002/lt.26220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end-stage liver disease. LDLT still only makes up a very small proportion of all liver transplantations performed each year, but there are many innovations taking place in the field that may increase its acceptance among both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through nondirected donation, paired exchange, transplant chains, transplant of ABO-incompatible donors, and transplants in patients with high Model for End-Stage Liver Disease scores. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy, and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center-level behavior, such as ensuring surgical expertise and providing culturally competent education, will help toward LDLT expansion. Although it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the past 2 years.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY
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Kute VB, Meshram HS, Patel HV, Engineer D, Banerjee S, Chauhan S, Navadiya VV, Patel H, Gupta A, Rizvi J, Mishra VV. First Single-Center Five-Way Kidney Exchange Cycle in India. INDIAN JOURNAL OF TRANSPLANTATION 2021; 15:338-342. [DOI: 10.4103/ijot.ijot_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective:
The logistical issues, limited resources, and surgical capacity are the challenges to simultaneous kidney exchange transplant surgeries in India. We report the first single-center 5-way nonsimultaneous kidney exchange cycle from India without donor renege. The challenges and solutions for the same are discussed.
Methods:
Five donor–recipient pairs (DRPs) participated in 5-way kidney exchange cycle after permission of Institutional and Gujarat State Level Authorization Committee for organ transplantation. Four DRP were ABO-incompatible and the fifth was compatible.
Results:
Two DRP were operated on November 22 and three on November 23, 2018. One bridge donor wait time was 1 day. All five recipients were discharged on November 30, 2018, without any medical or surgical complication; normal kidney allograft function and donor renege. We have increased chain length gradually from 2-way (June 2000), 3-way (February 2013), 4-way (April 2016), 5-way (November 2018), 6-way (February 2019), and 10-way (January 2020) in 440 kidney exchange transplants at our institute. We have used compatible pairs in gradually increasing chain length from 2-way (May 2012), 3-way (August 2013), 4-way (July 2018), 5-way (November 2018), and 6-way (February 2019) to increase transplant for difficult to match pairs.
Conclusions:
To the best of our knowledge, this is the first single-center 5-way kidney exchange cycle from India. Increasing chain length has the potential to offer better quality of matching and transplants rates for difficult-to-match pairs in kidney exchange.
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Braun HJ, Torres AM, Louie F, Weinberg S, Kang SM, Ascher NL, Roberts JP. Expanding living donor liver transplantation: Report of first US living donor liver transplant chain. Am J Transplant 2021; 21:1633-1636. [PMID: 33171017 PMCID: PMC8016700 DOI: 10.1111/ajt.16396] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/13/2020] [Accepted: 11/01/2020] [Indexed: 01/25/2023]
Abstract
Living donor liver transplantation (LDLT) enjoys widespread use in Asia, but remains limited to a handful of centers in North America and comprises only 5% of liver transplants performed in the United States. In contrast, living donor kidney transplantation is used frequently in the United States, and has evolved to commonly include paired exchanges, particularly for ABO-incompatible pairs. Liver paired exchange (LPE) has been utilized in Asia, and was recently reported in Canada; here we report the first LPE performed in the United States, and the first LPE to be performed on consecutive days. The LPE performed at our institution was initiated by a nondirected donor who enabled the exchange for an ABO-incompatible pair, and the final recipient was selected from our deceased donor waitlist. The exchange was performed over the course of 2 consecutive days, and relied on the use and compliance of a bridge donor. Here, we show that LPE is feasible at centers with significant LDLT experience and affords an opportunity to expand LDLT in cases of ABO incompatibility or when nondirected donors arise. To our knowledge, this represents the first exchange of its kind in the United States.
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Affiliation(s)
- Hillary J. Braun
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Ana Marie Torres
- Division of Transplantation, University of California, San Francisco, San Francisco, CA
| | - Finesse Louie
- Division of Transplantation, University of California, San Francisco, San Francisco, CA
| | - Sandy Weinberg
- Division of Transplantation, University of California, San Francisco, San Francisco, CA
| | - Sang-Mo Kang
- Department of Surgery, University of California, San Francisco, San Francisco, CA,Division of Transplantation, University of California, San Francisco, San Francisco, CA
| | - Nancy L. Ascher
- Department of Surgery, University of California, San Francisco, San Francisco, CA,Division of Transplantation, University of California, San Francisco, San Francisco, CA
| | - John P. Roberts
- Department of Surgery, University of California, San Francisco, San Francisco, CA,Division of Transplantation, University of California, San Francisco, San Francisco, CA
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14
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Kute VB, Patel HV, Modi PR, Rizvi SJ, Shah PR, Engineer DP, Banerjee S, Meshram HS, Butala BP, Modi MP, Gandhi S, Patel AH, Mishra VV, Roth AE, Kopke JE, Rees MA. Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation - a prospective single-center cohort study. Transpl Int 2021; 34:669-680. [PMID: 33527555 DOI: 10.1111/tri.13833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n = 67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging. We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using 23 bridge-donors without donor renege and no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pranjal R Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Syed J Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Divyesh P Engineer
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Bina P Butala
- Department of Anesthesia, IKDRC-ITS, Ahmedabad, India
| | | | - Shruti Gandhi
- Department of Radiology, IKDRC-ITS, Ahmedabad, India
| | | | | | | | | | - Michael A Rees
- Alliance for Paired Kidney Donation, Perrysburg, OH, USA
- University of Toledo Medical Center, Toledo, OH, USA
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15
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Wang W, Rees MA, Leichtman AB, Song PXK, Bray M, Ashby VB, Shearon T, Whiteman A, Kalbfleisch JD. Deceased donors as nondirected donors in kidney paired donation. Am J Transplant 2021; 21:103-113. [PMID: 32803856 PMCID: PMC9436421 DOI: 10.1111/ajt.16268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/25/2023]
Abstract
As proof of concept, we simulate a revised kidney allocation system that includes deceased donor (DD) kidneys as chain-initiating kidneys (DD-CIK) in a kidney paired donation pool (KPDP), and estimate potential increases in number of transplants. We consider chains of length 2 in which the DD-CIK gives to a candidate in the KPDP, and that candidate's incompatible donor donates to theDD waitlist. In simulations, we vary initial pool size, arrival rates of candidate/donor pairs and (living) nondirected donors (NDDs), and delay time from entry to the KPDP until a candidate is eligible to receive a DD-CIK. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Kidney Donation, and the actual DDs from the Scientific Registry of Transplant Recipients (SRTR) data, simulations extend over 2 years. With an initial pool of 400, respective candidate and NDD arrival rates of 2 per day and 3 per month, and delay times for access to DD-CIK of 6 months or less, including DD-CIKs increases the number of transplants by at least 447 over 2 years, and greatly reduces waiting times of KPDP candidates. Potential effects on waitlist candidates are discussed as are policy and ethical issues.
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Affiliation(s)
- W. Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - M. A. Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH
| | - A. B. Leichtman
- University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI,University of Michigan, Department of Medicine, Ann Arbor MI
| | - P. X-K. Song
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - M. Bray
- GSK, Research statistics. Collegeville, PA
| | - V. B. Ashby
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - T. Shearon
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - A Whiteman
- University of Michigan, Department of Biostatistics, Ann Arbor, MI
| | - J. D. Kalbfleisch
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
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16
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Turgeon NA. Deceased donor chains-It is time for debate and consensus. Am J Transplant 2021; 21:5-6. [PMID: 33080097 DOI: 10.1111/ajt.16362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Nicole A Turgeon
- Department of Surgery, University of Texas Dell Medical School, Austin, TX, USA
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17
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18
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Viklicky O, Krivanec S, Vavrinova H, Berlakovich G, Marada T, Slatinska J, Neradova T, Zamecnikova R, Salat A, Hofmann M, Fischer G, Slavcev A, Chromy P, Oberbauer R, Pantoflicek T, Wenda S, Lehner E, Fae I, Ferrari P, Fronek J, Böhmig GA. Crossing borders to facilitate live donor kidney transplantation: the Czech‐Austrian kidney paired donation program – a retrospective study. Transpl Int 2020; 33:1199-1210. [DOI: 10.1111/tri.13668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/22/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Ondrej Viklicky
- Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Sebastian Krivanec
- Division of Nephrology and Dialysis Department of Medicine III Medical University of Vienna Vienna Austria
| | - Hana Vavrinova
- Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | | | - Tomas Marada
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Janka Slatinska
- Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Tereza Neradova
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Renata Zamecnikova
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Andreas Salat
- Department of Surgery Medical University of Vienna Vienna Austria
| | - Michael Hofmann
- Department of Surgery Medical University of Vienna Vienna Austria
| | - Gottfried Fischer
- Department of Blood Group Serology and Transfusion Medicine Medical University of Vienna Vienna Austria
| | - Antonij Slavcev
- Department of Immunogenetics Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Pavel Chromy
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis Department of Medicine III Medical University of Vienna Vienna Austria
| | - Tomas Pantoflicek
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Sabine Wenda
- Department of Blood Group Serology and Transfusion Medicine Medical University of Vienna Vienna Austria
| | - Elisabeth Lehner
- Division of Nephrology and Dialysis Department of Medicine III Medical University of Vienna Vienna Austria
| | - Ingrid Fae
- Department of Blood Group Serology and Transfusion Medicine Medical University of Vienna Vienna Austria
| | - Paolo Ferrari
- Department of Nephrology Ospedale Civico Lugano, Ente Ospedaliero Cantonale Lugano Switzerland
- Biomedical Faculty Università della Svizzera Italiana Lugano Switzerland
- Clinical School University of New South Wales Sydney NSW Australia
| | - Jiri Fronek
- Department of Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Georg A. Böhmig
- Division of Nephrology and Dialysis Department of Medicine III Medical University of Vienna Vienna Austria
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19
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Affiliation(s)
- Bushra Syed
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - Joshua J Augustine
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
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20
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Martin WP, White J, López-Hernández FJ, Docherty NG, le Roux CW. Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions? Front Endocrinol (Lausanne) 2020; 11:289. [PMID: 33013677 PMCID: PMC7462008 DOI: 10.3389/fendo.2020.00289] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- *Correspondence: William P. Martin
| | - James White
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Francisco J. López-Hernández
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Hospital Virgen Vega, Salamanca, Spain
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- Division of Investigative Science, Imperial College London, London, United Kingdom
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21
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Flechner SM, Thomas AG, Ronin M, Veale JL, Leeser DB, Kapur S, Peipert JD, Segev D, Henderson ML, Shaffer AA, Cooper M, Hil G, Waterman AD. The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries. Am J Transplant 2018; 18:2730-2738. [PMID: 29603640 PMCID: PMC6165704 DOI: 10.1111/ajt.14744] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 01/25/2023]
Abstract
The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR. Compared with all United Network for Organ Sharing (UNOS) live donor transplant patients (49 610), all UNOS living unrelated transplant patients (23 319), and all other KPD transplant patients (4236), the demographic and clinical characteristics of NKR transplant patients (2037) appear similar to contemporary national trends. In particular, among the NKR patients, there were a significantly (P < .001) greater number of retransplants (25.6% vs 11.5%), hyperimmunized recipients (22.7% vs 4.3% were cPRA >80%), female recipients (45.9% vs 37.6%), black recipients (18.2% vs 13%), and those on public insurance (49.7% vs 41.8%) compared with controls. These results support the need for greater sharing and larger pool sizes, perhaps enhanced by the entry of compatible pairs and even chains initiated by deceased donors, to unlock more opportunities for those harder-to-match pairs.
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Affiliation(s)
| | | | | | | | | | | | - John D Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | | | | | | | | | - Garet Hil
- National Kidney Registry, Babylon, NY
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22
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Cohen J, Owei L, Sawinski D, Porrett P. Inferior long-term allograft and patient outcomes among recipients of offspring living donor kidneys. Am J Transplant 2018; 18:1699-1709. [PMID: 29266831 PMCID: PMC6013327 DOI: 10.1111/ajt.14631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 01/25/2023]
Abstract
While offspring-to-parent living donor kidney transplantations may represent an ideal donor-recipient combination to optimize long-term transplantation outcomes, the sex-specific long-term success of these transplantations remains unclear. We hypothesize that allograft and recipient survivals in offspring-to-parent living donor kidney transplantation differ between men and women due to donor-specific alloimmunization during pregnancy. We retrospectively analyzed long-term allograft and patient survival among men and women who received an offspring living donor kidney compared with those who received other haplotype-matched living donor kidneys. Based on multivariable Cox proportional hazards modeling of Organ Procurement and Transplantation Network data from 2001 to 2015, we found that both men and women who received offspring living donor kidneys had significantly increased mortality compared with recipients who received nonoffspring living donor kidneys. While male recipients of any living donor kidney had greater risk of mortality and allograft failure than female recipients, there was no significant difference in all-cause allograft failure or mortality in male versus female recipients of offspring living donor kidney transplantations. Our analysis demonstrated no significant interaction between recipient sex and donor offspring status. We conclude that nonoffspring living donors should be considered whenever feasible for both men and women with multiple donor options.
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Affiliation(s)
- J.B. Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L. Owei
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D.L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P.M. Porrett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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23
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Kute VB, Prasad N, Shah PR, Modi PR. Kidney exchange transplantation current status, an update and future perspectives. World J Transplant 2018; 8:52-60. [PMID: 29988896 PMCID: PMC6033740 DOI: 10.5500/wjt.v8.i3.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 02/05/2023] Open
Abstract
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Narayan Prasad
- Department of Nephrology and Clinical Transplantation, SGPGI, Lucknow 226014, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Pranjal R Modi
- Department of Urology and transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
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24
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Mishra A, Lo A, Lee GS, Samstein B, Yoo PS, Levine MH, Goldberg DS, Shaked A, Olthoff KM, Abt PL. Liver paired exchange: Can the liver emulate the kidney? Liver Transpl 2018; 24:677-686. [PMID: 29427562 DOI: 10.1002/lt.25030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.
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Affiliation(s)
- Ashish Mishra
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexis Lo
- Temple University School of Medicine, Philadelphia, PA
| | - Grace S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Matthew H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abraham Shaked
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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25
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Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-Paired Donation to Increase Living Donor Kidney Transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017. Indian J Nephrol 2018; 28:1-9. [PMID: 29515294 PMCID: PMC5830802 DOI: 10.4103/ijn.ijn_365_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Artemis Hospital, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Anant Kumar
- Department of Transplantation Surgery, Max Group of Hospital, New Delhi, India
| | - Manish Rathi
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajkumar K. Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishan L. Gupta
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Shroff
- Department of Transplantation Surgery, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Sandip K. Saxena
- Department of Nephrology, Apollo Hospital, Indore, Madhya Pradesh, India
| | - Pankaj R. Shah
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Pranjal R. Modi
- Department of Transplantation Surgery Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vishwanath Billa
- Department of Nephrology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dhamedndra S. Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tarun K. Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | | | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Rajshekhar Perumalla
- Department of Transplantation Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India
| | - Manoj Jain
- Department of Renal Pathology Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael A. Rees
- Department of Transplantation Surgery, University of Toledo Medical Center, Toledo, Ohio
- CEO, Alliance for Paired Donation, USA
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