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Zeng J, Ma M, Jiang X, Rao Z, Huang D, Zhang H, Yin S, Bao R, Zhang H, Wang Z, Gao H, Gong F, Lin T, Zhang K, Song T. Enzymatic conversion of blood group B kidney prevents hyperacute antibody-mediated injuries in ABO-incompatible transplantation. Nat Commun 2025; 16:1506. [PMID: 39929829 PMCID: PMC11810989 DOI: 10.1038/s41467-025-56563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 01/21/2025] [Indexed: 02/13/2025] Open
Abstract
Matching ABO blood group antigens between donors and recipients is critical to prevent hyperacute rejection in kidney transplantation. Enzymatic conversion of blood group antigens to the universal O type presents a promising strategy to overcome barriers in ABO-incompatible kidney transplantation. In this study, we employ α-galactosidase from Bacteroides fragilis to convert type B kidneys to type O during hypothermic machine perfusion. After 3 hours of perfusion with enzyme, more than 95% of blood group B antigens in the kidney endothelium are effectively removed. Subsequently, enzyme-treated kidneys are protected from antibody-mediated injuries in an ex vivo simulation of ABO-incompatible kidney transplantation. Encouraged by these results, a discarded type B kidney, following enzymatic conversion, is transplanted into a type O brain-dead recipient with high titer of anti-B antibody. The allograft survives for 63 hours without hyperacute rejection. Blood group B antigens re-express within 48 hours, with histopathological analyses indicating no evidence of antibody-mediated rejection. This enzymatic conversion approach holds the potential to broaden the practice of ABO-incompatible kidney transplantation, decrease waiting times and facilitate equitable organ allocation.
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Affiliation(s)
- Jun Zeng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Ma
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Transplant Center and NHC Key Lab of Transplant Engineering and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaojuan Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhengsheng Rao
- Center of urology and nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Huang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Green Chemistry and Technology of Ministry of Education, College of Chemistry, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Saifu Yin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Bao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haohan Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiling Wang
- Center of urology and nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongwei Gao
- Department of Blood Biochemistry and Molecular Biology, Beijing Institute of Transfusion Medicine, Beijing, China
| | - Feng Gong
- Department of Blood Biochemistry and Molecular Biology, Beijing Institute of Transfusion Medicine, Beijing, China
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Keqin Zhang
- Center of urology and nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Turun Song
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Kidney Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Kute VB, Patel HV, Banerjee S, Engineer DP, Dave RB, Shah N, Chauhan S, Meshram H, Tambi P, Shah A, Saxena K, Balwani M, Parmar V, Shah S, Prakash V, Patel S, Patel D, Desai S, Rizvi J, Patel H, Parikh B, Kanodia K, Gandhi S, Rees MA, Roth AE, Modi P. Impact of single centre kidney-exchange transplantation to increase living donor pool in India: A cohort study involving non-anonymous allocation. Nephrology (Carlton) 2024; 29:917-929. [PMID: 39245449 DOI: 10.1111/nep.14380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024]
Abstract
AIM 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%. METHODS We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT. RESULTS 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. CONCLUSION This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs.
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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
| | - 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
| | - 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
| | - Ruchir B Dave
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Nauka 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
| | - Sanshriti Chauhan
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Harishankar 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
| | - Priyash Tambi
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Akash 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
| | - Khushboo Saxena
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Manish Balwani
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vishal Parmar
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Shivam 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
| | - Ved Prakash
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sudeep 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
| | - Dev 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
| | - Sudeep Desai
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Jamal Rizvi
- Department of Urology and Transplantation, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Harsh 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
| | - Beena Parikh
- Department of Anaesthesiology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Kamal Kanodia
- Department of Pathology, laboratory medicine, transfusion services and immunohematology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Shruti Gandhi
- Department of Radiology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Michael A Rees
- Alliance for Paired Kidney Donation, Perrysburg, Ohio, USA
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, California, USA
| | - Pranjal Modi
- Department of Urology and Transplantation, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
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Ali H, Mohammed M, Molnar MZ, Fülöp T, Burke B, Shroff S, Shroff A, Briggs D, Krishnan N. Live-Donor Kidney Transplant Outcome Prediction (L-TOP) using artificial intelligence. Nephrol Dial Transplant 2024; 39:2088-2099. [PMID: 38684469 DOI: 10.1093/ndt/gfae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Outcome prediction for live-donor kidney transplantation improves clinical and patient decisions and donor selection. However, the currently used models are of limited discriminative or calibration power and there is a critical need to improve the selection process. We aimed to assess the value of various artificial intelligence (AI) algorithms to improve the risk stratification index. METHODS We evaluated pre-transplant variables among 66 914 live-donor kidney transplants (performed between 1 December 2007 and 1 June 2021) from the United Network of Organ Sharing database, randomized into training (80%) and test (20%) sets. The primary outcome measure was death-censored graft survival. We tested four machine learning models for discrimination [time-dependent concordance index (CTD) and area under the receiver operating characteristic curve (AUC)] and calibration [integrated Brier score (IBS)]. We used decision-curve analysis to assess the potential clinical utility. RESULTS Among the models, the deep Cox mixture model showed the best discriminative performance (AUC = 0.70, 0.68 and 0.68 at 5, 10 and 13 years post-transplant, respectively). CTD reached 0.70, 0.67 and 0.66 at 5, 10 and 13 years post-transplant. The IBS score was 0.09, indicating good calibration. In comparison, applying the Living Kidney Donor Profile Index (LKDPI) on the same cohort produced a CTD of 0.56 and an AUC of 0.55-0.58 only. Decision-curve analysis showed an additional net benefit compared with the LKDPI 'treat all' and 'treat none' approaches. CONCLUSION Our AI-based deep Cox mixture model, termed Live-Donor Kidney Transplant Outcome Prediction, outperforms existing prediction models, including the LKDPI, with the potential to improve decisions for optimum live-donor selection by ranking potential transplant pairs based on graft survival. This model could be adopted to improve the outcomes of paired exchange programs.
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Affiliation(s)
- Hatem Ali
- Renal Department, University Hospitals of Coventry and Warwickshire, Coventry, UK
- Research Centre for Health and Life Sciences, Coventry University, Coventry, UK
| | - Mahmoud Mohammed
- Department of Internal Medicine and Nephrology, University Hospitals of Mississippi, Mississippi, USA
| | - Miklos Z Molnar
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University South Carolina, Charleston, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Bernard Burke
- Research Centre for Health and Life Sciences, Coventry University, Coventry, UK
| | - Sunil Shroff
- CEO, Xtend.AI, CTO, Medindia.net, Technology Adviser, MOHAN Foundation
| | - Arun Shroff
- CEO, Xtend.AI, CTO, Medindia.net, Technology Adviser, MOHAN Foundation
| | - David Briggs
- Histocompatibility and Immunogenetics Laboratory, Birmingham Centre, NHS Blood and Transplant, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Nithya Krishnan
- Renal Department, University Hospitals of Coventry and Warwickshire, Coventry, UK
- Research Centre for Health and Life Sciences, Coventry University, Coventry, UK
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MacMillan S, Hosgood SA, Walker-Panse L, Rahfeld P, Macdonald SS, Kizhakkedathu JN, Withers SG, Nicholson ML. Enzymatic conversion of human blood group A kidneys to universal blood group O. Nat Commun 2024; 15:2795. [PMID: 38555382 PMCID: PMC10981661 DOI: 10.1038/s41467-024-47131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024] Open
Abstract
ABO blood group compatibility restrictions present the first barrier to donor-recipient matching in kidney transplantation. Here, we present the use of two enzymes, FpGalNAc deacetylase and FpGalactosaminidase, from the bacterium Flavonifractor plautii to enzymatically convert blood group A antigens from the renal vasculature of human kidneys to 'universal' O-type. Using normothermic machine perfusion (NMP) and hypothermic machine perfusion (HMP) strategies, we demonstrate blood group A antigen loss of approximately 80% in as little as 2 h NMP and HMP. Furthermore, we show that treated kidneys do not bind circulating anti-A antibodies in an ex vivo model of ABO-incompatible transplantation and do not activate the classical complement pathway. This strategy presents a solution to the donor organ shortage crisis with the potential for direct clinical translation to reduce waiting times for patients with end stage renal disease.
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Affiliation(s)
| | - Sarah A Hosgood
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Peter Rahfeld
- Avivo Biomedical Inc., Vancouver, BC, Canada
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | - Spence S Macdonald
- Avivo Biomedical Inc., Vancouver, BC, Canada
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Centre for Blood Research, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Stephen G Withers
- Department of Chemistry, University of British Columbia, Vancouver, BC, Canada
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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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Irish GL, McMichael LC, Kadatz M, Boudville N, Campbell S, Chadban S, Chang D, Kanellis J, Sharples E, Gill JS, Clayton PA. The living kidney donor profile index fails to discriminate allograft survival: implications for its use in kidney paired donation programs. Am J Transplant 2023; 23:232-238. [PMID: 36804131 DOI: 10.1016/j.ajt.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 02/19/2023]
Abstract
The inclusion of blood group- and human leukocyte antigen-compatible donor and recipient pairs (CPs) in kidney paired donation (KPD) programs is a novel strategy to increase living donor (LD) transplantation. Transplantation from a donor with a better Living Donor Kidney Profile Index (LKDPI) may encourage CP participation in KPD programs. We undertook parallel analyses using data from the Scientific Registry of Transplant Recipients and the Australia and New Zealand Dialysis and Transplant Registry to determine whether the LKDPI discriminates death-censored graft survival (DCGS) between LDs. Discrimination was assessed by the following: (1) the change in the Harrell C statistic with the sequential addition of variables in the LKDPI equation to reference models that included only recipient factors and (2) whether the LKDPI discriminated DCGS among pairs of prognosis-matched LD recipients. The addition of the LKDPI to reference models based on recipient variables increased the C statistic by only 0.02. Among prognosis-matched pairs, the C statistic in Cox models to determine the association of the LKDPI with DCGS was no better than chance alone (0.51 in the Scientific Registry of Transplant Recipient and 0.54 in the Australia and New Zealand Dialysis and Transplant Registry cohorts). We conclude that the LKDPI does not discriminate DCGS and should not be used to promote CP participation in KPD programs.
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Affiliation(s)
- Georgina L Irish
- Transplant Epidemiology Group, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lachlan C McMichael
- Transplant Epidemiology Group, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Kidney Transplant Program, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Kadatz
- Kidney Transplant Program, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Scott Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia; Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Doris Chang
- Transplant Research, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - John Kanellis
- Department of Nephrology, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | | | - John S Gill
- Kidney Transplant Program, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Transplant Research, Providence Health Research Institute, Vancouver, British Columbia, Canada; Tufts-New England Medical Center, Boston, Massachusetts, USA.
| | - Philip A Clayton
- Transplant Epidemiology Group, Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Xu Y, Umatheva U, Ghosh R. Evaluation of a Novel Cuboid Hollow Fiber Hemodialyzer Design Using Computational Fluid Dynamics. MEMBRANES 2023; 13:membranes13010093. [PMID: 36676900 PMCID: PMC9863327 DOI: 10.3390/membranes13010093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/06/2023]
Abstract
Conventional hollow fiber hemodialyzers have a cylindrical shell-and-tube design. Due to their circular cross-section and radial flow distribution and collection in the headers, the flow of blood in the header as well as in the hollow fiber membranes is non-uniform. The creation of high shear stress and high shear rate zones or stagnation zones could result in problems, such as cell lysis and blood clotting. In this paper, a novel cuboid hemodialyzer design is proposed as an alternative to the conventional cylindrical hemodialyzer. The primary motivation behind the proposed design is to create uniform flow conditions and thereby minimize some of the above-mentioned adverse effects. The most salient feature of the proposed design is a cuboid shell within which the hollow fiber membrane bundle is potted. The lumen of the fibers is fed from one side using a flow distributor consisting of embedded primary and secondary channels, while the fibers are drained from the other side using a flow collector, which also has embedded primary and secondary channels. The flow characteristics of the lumen side of the cuboid hemodialyzer were compared with those of a conventional hemodialyzer based on computational fluid dynamics (CFD) simulations. The results of CFD simulations clearly indicated that the flow of liquid within the cuboid dialyzer was significantly more uniform. Consequently, the shear rate and shear stress were also more uniform. By adopting this new design, some of the problems associated with the conventional hemodialyzer design could potentially be addressed.
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Affiliation(s)
| | | | - Raja Ghosh
- Correspondence: ; Tel.: +1-905-525-9140 (ext. 27415)
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Fung WWS, Chapman J, Nangaku M, Li PKT. Controversies in Living Kidney Donation. Semin Nephrol 2022; 42:151270. [PMID: 36577646 DOI: 10.1016/j.semnephrol.2022.07.004] [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: 12/28/2022]
Abstract
The most precious gift that can be given is, arguably, a living organ to a person in need of replacement because of failure of that organ. Kidney transplantation remains the best modality of renal replacement therapy and there is an ever-increasing demand for organ donation. The inability of cadaveric organ donation to meet the needs of the increasing numbers of patients on global waiting lists highlights the important needs for alternate sources for kidneys such as those from living kidney donation. However, living donor kidney transplantation has been a focus of intense debate, with ethical concerns and controversies emanating from operating on an individual who does not need, and is put at a small but quantifiable risk from, the surgical intervention. Furthermore, health care systems across the world also are funded with different levels of national and individual affordability, leading to health inequalities for the sick and risks of exploitation for the poor, especially through commercialization of transplantation. This article highlights some of these contemporary ethical concerns and controversies in living organ donation.
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Affiliation(s)
- Winston Wing-Shing Fung
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Jeremy Chapman
- Department of Medicine, Westmead Clinical School, The University of Sydney, Westmead New South Wales, Australia
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
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9
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Chandra Shrestha P, Bhandari TR, Adhikari R, Baral H, Verma RK, Shrestha KK. Living donor kidney paired exchange: An observational study. Ann Med Surg (Lond) 2022; 78:103761. [PMID: 35734678 PMCID: PMC9206995 DOI: 10.1016/j.amsu.2022.103761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESKD). Kidney paired donation (KPD) provides the chance to match an incompatible donor/recipient pair with another donor and recipient in a similar condition. We aimed to compare the outcomes of pair exchange kidney transplantation with traditional live donor kidney transplantation in our context. Method A review of medical records of 62 patients (31 pairs) who underwent two-way conventional living kidney pair exchange from July 2016 to June 2021 was done. The control group was considered those 62 patients who had undergone classic live donor kidney transplantation (LDKT) during the study period. The patient's demographics, intraoperative and postoperative variables including delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates were compared between the groups (KPD and LDKT). Results The majority of recipients were male (77.4 and 80.6%) while donors were female (77.4 and 69.4%) in KPD and the LDKT groups. Mean ages were 37 years (range: 19–59) and 37 years (range: 17–65) for the recipient's in KPD and the LDKT. KPD transplantation was performed in 62 recipients to avoid blood group incompatibility. There were no significant differences in outcomes comprising delayed graft function (1.6 and 3.2%), graft survival (100% in both groups), patient survival (95.2 and 96.8%), and rejections rates (1.6 and 1.6%) between KPD and LDKT group (P > 0.005). The length of stay was similar (5.9 and 5.7 days) in KPD and LDKT groups (P > 0.005). Conclusions The outcomes of KPD were comparable with classic LDKT in terms of delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates in our study. Therefore, the kidney paired donation program should be encouraged and promoted in centers where the ABO-incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low.
Kidney paired donation (KPD) provides the chance to match for an incompatible donor/recipient pair with another donor and recipient in a similar condition. The outcomes of KPD were comparable with classic live donor kidney transplantation (LDKT) in this study. KPD program should be promoted in centers where the ABO incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low.
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Affiliation(s)
- Pukar Chandra Shrestha
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Tika Ram Bhandari
- Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
- Corresponding author. Department of Transplant Surgery, Shahid Dharmabhakta National Transplant Centre (SDNTC), Bhaktapur, Nepal.
| | - Rojan Adhikari
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Hari Baral
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
| | - Rakesh Kumar Verma
- Department of Urology, Shahid Dharmabhakta National Transplant Centre, Bhaktapur, Nepal
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10
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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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11
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Machado DJDB, Nahas WC, David Neto E. Pioneering Experience of First Kidney Paired Donation in Brazil. J Bras Nefrol 2022; AOP:462-463. [PMID: 35113126 PMCID: PMC9518628 DOI: 10.1590/2175-8239-jbn-2021-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - William Carlos Nahas
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, São Paulo, SP, Brasil
| | - Elias David Neto
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, São Paulo, SP, Brasil
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12
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Chipman V, Cooper M, Thomas AG, Ronin M, Lee B, Flechner S, Leeser D, Segev DL, Mandelbrot DA, Lunow-Luke T, Syed S, Hil G, Freise CE, Waterman AD, Roll GR. Motivations and outcomes of compatible living donor-recipient pairs in paired exchange. Am J Transplant 2022; 22:266-273. [PMID: 34467618 PMCID: PMC10016327 DOI: 10.1111/ajt.16821] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 01/25/2023]
Abstract
Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan-Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p < .001), less often female (52% vs. 68%, p < .01), higher BMI (27 vs. 25 kg/m², p = .03), less frequently blood type O (36% vs. 80%, p < .001), and had higher eGFR (99 vs. 94 ml/min/1.73 m², p = .02), with a better LKDPI (median 7 vs. 22, p < .001). We observed no differences in graft failure or mortality. Compatible pairs made 280 additional transplants possible, many in highly sensitized recipients with long wait times. Compatible pair recipients derived several benefits from paired exchange, including better donor quality. Living donor pairs should receive counseling regarding all options available, including kidney paired donation. As more compatible pairs choose to enter exchange programs, consideration should be given to optimizing compatible pair and hard-to-transplant recipient outcomes.
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Affiliation(s)
- Valerie Chipman
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA.,Donor Network West, San Ramon, California, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University, Washington, District of Columbia, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Brian Lee
- Department of Medicine, University of California, San Francisco, California, USA
| | - Stuart Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Leeser
- Department of Surgery, East Carolina University, Greenville, North Carolina, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
| | | | - Tyler Lunow-Luke
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
| | - Shareef Syed
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
| | - Garet Hil
- National Kidney Registry, Babylon, New York, USA
| | - Chris E Freise
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
| | - Amy D Waterman
- Department of Medicine, University of California, Los Angeles, California, USA.,Terasaki Institute of Biomedical Innovation, Los Angeles, California, USA
| | - Garrett R Roll
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
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13
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Osbun N, Thomas AG, Ronin M, Cooper M, Flechner SM, Segev DL, Veale JL. The benefit to waitlist patients in a national paired kidney exchange program: Exploring characteristics of chain end living donor transplants. Am J Transplant 2022; 22:113-121. [PMID: 34212501 PMCID: PMC8720056 DOI: 10.1111/ajt.16749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/27/2021] [Accepted: 06/27/2021] [Indexed: 01/25/2023]
Abstract
Nondirected kidney donors can initiate living donor chains that end to patients on the waitlist. We compared 749 National Kidney Registry (NKR) waitlist chain end transplants to other transplants from the NKR and the Scientific Registry of Transplant Recipients between February 2008 and September 2020. Compared to other NKR recipients, chain end recipients were more often older (53 vs. 52 years), black (32% vs. 15%), publicly insured (71% vs. 46%), and spent longer on dialysis (3.0 vs. 1.0 years). Similar differences were noted between chain end recipients and non-NKR living donor recipients. Black patients received chain end kidneys at a rate approaching that of deceased donor kidneys (32% vs. 34%). Chain end donors were older (52 vs. 44 years) with slightly lower glomerular filtration rates (93 vs. 98 ml/min/1.73 m2 ) than other NKR donors. Chain end recipients had elevated risk of graft failure and mortality compared to control living donor recipients (both p < .01) but lower graft failure (p = .03) and mortality (p < .001) compared to deceased donor recipients. Sharing nondirected donors among a multicenter network may improve the diversity of waitlist patients who benefit from living donation.
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Affiliation(s)
- Nathan Osbun
- Department Urology, University of California Los Angeles, Los Angeles, CA
| | - Alvin G. Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC,Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | | | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, MD,Department of Epidemiology, Johns Hopkins University, Baltimore, MD,Scientific Registry of Transplant Recipients, Minnesota, MN
| | - Jeffrey L. Veale
- Department Urology, University of California Los Angeles, Los Angeles, CA
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14
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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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15
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Kher V, Jha PK. Paired kidney exchange transplantation - pushing the boundaries. Transpl Int 2020; 33:975-984. [PMID: 32634850 DOI: 10.1111/tri.13693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/02/2019] [Accepted: 07/01/2020] [Indexed: 12/28/2022]
Abstract
The scarcity of living organ donors makes it imperative to develop newer innovations to optimize and maximize the utilization of the available pool. ABO and HLA sensitization are important immunological barriers in renal transplant and can potentially lead to rejection of almost one-third of the willing living donors. Paired kidney exchange (PKE) is a rapidly growing method used to overcome these barriers and has grown in popularity over the last three decades since its introduction in 1986. Evolution of the matching strategies and use of complex algorithms has led to increase in the number of possible matches thereby benefiting multiple recipients. The use of altruistic donors and compatible pairs has also helped in increasing the possible exchanges. This review provides an in-depth analysis of the evolution, the present global scenario, and the future of PKE. It also discusses the recent trends of advanced donation, trans-organ paired exchange and global kidney exchange and the associated ethical concerns.
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Affiliation(s)
- Vijay Kher
- Department of Nephrology & Transplant Medicine, Medanta - The Medicity, Gurgaon, Harayana, India
| | - Pranaw Kumar Jha
- Department of Nephrology & Transplant Medicine, Medanta - The Medicity, Gurgaon, Harayana, India
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16
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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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17
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Yamanaga S, Freise CE, Stock PG, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Kang SM. Inferior Long-Term Graft Survival of Suboptimal Kidneys After Living Donor Kidney Transplantation. Transplant Proc 2020; 52:1734-1740. [PMID: 32446691 DOI: 10.1016/j.transproceed.2020.01.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In living donors, if both kidneys are considered to be of equal quality, the side with favorable anatomy for transplant is usually selected. A "suboptimal kidney" is a kidney that has a significant abnormality and is chosen to maintain the principle of leaving the better kidney with the donor. We hypothesized that the long-term outcome of suboptimal kidney is inferior to that of the normal kidney. METHODS In a retrospective analysis of 1744 living donor kidney transplantations performed between 1999 and 2015 at our institution, 172 allografts were considered as a suboptimal kidney (9.9%). Median length of follow-up after living donor kidney transplantation was 59.5 months (interquartile range 26.3-100.8). This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source. RESULTS The reasons for suboptimal kidneys were cysts or tumors (46.5%), arterial abnormalities (22.7%), inferior size or function (19.8%), and anatomic abnormalities (11.0%). Suboptimal kidneys showed worse long-term overall graft survival regardless of the reasons (5-year: control vs suboptimal kidney; 88.9% vs 79.3%, P = .001 and 10-year: 73.6% vs 63.5%, P = .004). Suboptimal kidneys showed a 1.6-fold higher adjusted hazard ratio (aHR) of all-cause graft loss (95% confidence interval [CI]: 1.1-2.5, P = .025) and had the same impact as older donor age (≥ 54 years old, aHR: 1.6, 95% CI: 1.1-2.4, P = .008). CONCLUSIONS The impact of suboptimal kidney should be factored into the donor selection process.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Chris E Freise
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Peter G Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
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18
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Holscher CM, Jackson KR, Segev DL. Transplanting the Untransplantable. Am J Kidney Dis 2020; 75:114-123. [DOI: 10.1053/j.ajkd.2019.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
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19
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van Sandwijk MS, Klooster A, ten Berge IJM, Diepstra A, Florquin S, Hoelbeek JJ, Bemelman FJ, Sanders JS. Complement activation and long-term graft function in ABO-incompatible kidney transplantation. World J Nephrol 2019; 8:95-108. [PMID: 31662955 PMCID: PMC6817790 DOI: 10.5527/wjn.v8.i6.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/29/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ABO-incompatible and ABO-compatible kidney transplantation are equivalent in terms of short-term graft and patient survival. This is thought to be the result of ABO-incompatible graft accommodation, which occurs when anti-blood group antibodies re-occur after transplantation but somehow do not yield their detrimental effect. The underlying mechanism is unclear, but one of the hypotheses is that this is the result of complement inhibition. Since virtually all ABO-incompatible graft biopsies are C4d positive, this complement inhibition must occur somewhere in the complement cascade after the formation of C4d has already taken place, but where exactly is unclear. It is also unclear whether complement inhibition is complete. Incomplete accommodation could explain why recent studies have shown that long-term graft function in ABO-incompatible transplantation is somewhat inferior to ABO-compatible kidney transplantation.
AIM To unravel the relationship between pre-transplant anti-ABO antibodies, complement activation, and long-term graft function.
METHODS We included all 27 ABO-incompatible transplantations that were performed between 2008 and 2013 at the Academic Medical Center Amsterdam and the University Medical Center Groningen. For each ABO-incompatible transplantation, we included four ABO-compatible controls matched by age, sex, and transplantation date.
RESULTS Graft and patient survival were not significantly different. The slope of kidney function during five-year follow-up was also not significantly different, but ABO-incompatible recipients did have a lower kidney function at three months (creatinine clearance 58 vs 69 mL/min, P = 0.02, Modification of Diet in Renal Disease 46 vs 52 mL/min/1.73 m2, P = 0.08), due to a high rate of early rejection (33% vs 15%, P = 0.03), mostly T-cell mediated. Pre-transplant anti-ABO IgG titers were positively correlated with C5b-9 staining, which itself was positively correlated with the occurrence of T-cell mediated rejection. This may be the result of concurrent C5a formation, which could function as a costimulatory signal for T-cell activation.
CONCLUSION Co-stimulation of T-cell activation by ongoing complement activation by anti-ABO antibodies may be responsible for an impaired long-term graft function in ABO-incompatible kidney transplantation.
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Affiliation(s)
- Marit S van Sandwijk
- Department of Nephrology, Amsterdam University Medical Centers, Amsterdam NL-1105 AZ, Netherlands
- Dianet Dialysis Center, Amsterdam NL-1105 AZ, Netherlands
| | - Astrid Klooster
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen NL-9700 RB, Netherlands
- Department of Pathology, Pathology Friesland, Leeuwarden NL-8917 EN, Netherlands
| | - Ineke JM ten Berge
- Department of Nephrology, Amsterdam University Medical Centers, Amsterdam NL-1105 AZ, Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen NL-9700 RB, Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam NL-1105 AZ, Netherlands
| | - Joris J Hoelbeek
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam NL-1105 AZ, Netherlands
| | - Frederike J Bemelman
- Department of Nephrology, Amsterdam University Medical Centers, Amsterdam NL-1105 AZ, Netherlands
| | - Jan-Stephan Sanders
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen NL-9700 RB, Netherlands
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20
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Wasik H, Pruette C, Ruebner R, McAdams-DeMarco M, Zhou S, Neu A, Segev D, Massie A. A donor risk index for graft loss in pediatric living donor kidney transplantation. Am J Transplant 2019; 19:2775-2782. [PMID: 30875148 PMCID: PMC6745273 DOI: 10.1111/ajt.15360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 03/10/2019] [Indexed: 01/25/2023]
Abstract
Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch = 1.04 1.271.55 ), HLA-DR mismatch (aHR per mismatch = 1.02 1.231.49 ), ABO incompatibility (aHR = 1.20 3.268.81 ), donor systolic blood pressure (aHR per 10 mm Hg = 1.01 1.071.18 ), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m2 = 0.88 0.940.99 ) were associated with graft loss after LDKT. Median (interquartile range [IQR]) P-LKDPI was -25 (-56 to 12). 68% of donors had P-LKDPI <0 (less risk than any DD kidney) and 25% of donors had P-LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P-LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P-LDKPI ≥20, 28% for 20> P-LKDPI ≥-20, 23% for -20 > P-LKDPI ≥-60, 19% for P-LKDPI <-60 [log rank P < .001]). The P-LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.
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Affiliation(s)
- Heather Wasik
- Department of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cozumel Pruette
- Department of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca Ruebner
- Department of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sheng Zhou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alicia Neu
- Department of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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21
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Bray M, Wang W, Rees MA, Song PXK, Leichtman AB, Ashby VB, Kalbfleisch JD. KPDGUI: An interactive application for optimization and management of a virtual kidney paired donation program. Comput Biol Med 2019; 108:345-353. [PMID: 31054501 DOI: 10.1016/j.compbiomed.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim in kidney paired donation (KPD) is typically to maximize the number of transplants achieved through the exchange of donors in a pool comprising incompatible donor-candidate pairs and non-directed (or altruistic) donors. With many possible options in a KPD pool at any given time, the most appropriate set of exchanges cannot be determined by simple inspection. In practice, computer algorithms are used to determine the optimal set of exchanges to pursue. Here, we present our software application, KPDGUI (Kidney Paired Donation Graphical User Interface), for management and optimization of KPD programs. METHODS While proprietary software platforms for managing KPD programs exist to provide solutions to the standard KPD problem, our application implements newly investigated optimization criteria that account for uncertainty regarding the viability of selected transplants and arrange for fallback options in cases where potential exchanges cannot proceed, with intuitive resources for visualizing alternative optimization solutions. RESULTS We illustrate the advantage of accounting for uncertainty and arranging for fallback options in KPD using our application through a case study involving real data from a paired donation program, comparing solutions produced under different optimization criteria and algorithmic priorities. CONCLUSIONS KPDGUI is a flexible and powerful tool for offering decision support to clinicians and researchers on possible KPD transplant options to pursue under different user-specified optimization schemes.
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Affiliation(s)
- Mathieu Bray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA.
| | - Wen Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - Michael A Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH, USA; Alliance for Paired Donation, Inc., Maumee, OH, USA
| | - Peter X-K Song
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | | | - Valarie B Ashby
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
| | - John D Kalbfleisch
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI, USA
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22
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Stepkowski SM, Mierzejewska B, Fumo D, Bekbolsynov D, Khuder S, Baum CE, Brunner RJ, Kopke JE, Rees SE, Smith C, Ashlagi I, Roth AE, Rees MA. The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study. Transpl Int 2019; 32:839-853. [PMID: 30848501 DOI: 10.1111/tri.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/11/2018] [Accepted: 03/04/2019] [Indexed: 01/10/2023]
Abstract
We examined what happened during a 6-year period to 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchanges with the Alliance for Paired Donation (APD). Of all patients, 65% were transplanted: 37% in kidney paired donation (APD-KPD, APD-other-KPD); 10% with compatible live donors (APD-LD); and 18% with deceased donors (APD-DD). The remaining patients were withdrawn (sick/died/others; 15%), or were still waiting (20%). For those patients with a cPRA 0-94%, 72% received a transplant. In contrast, only 49% of very highly sensitized (VHS; cPRA 95-100%) were transplanted. Of the VHS patients, 50% were transplanted by KPD/APD-LD while 50% benefited through prioritization of deceased donors in the modified kidney allocation system (KAS introduced in 2014). All APD transplanted groups had similar death-censored 4-year graft survivals as their relevant Organ Procurement and Transplantation Network (OPTN) groups. It is noteworthy that VHS graft and patient survival results were comparable to less sensitized and nonsensitized patients. All patients should be encouraged to search for compatible donors through different options. Expanding the donor pool through KPD and the new KAS of the OPTN increases the likelihood of transplantation for VHS patients.
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Affiliation(s)
- Stanislaw M Stepkowski
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA.,The Alliance for Paired Donation, Maumee, OH, USA
| | - Beata Mierzejewska
- The Alliance for Paired Donation, Maumee, OH, USA.,Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | - David Fumo
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | - Dulat Bekbolsynov
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik Khuder
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Caitlin E Baum
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA
| | - Robert J Brunner
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Susan E Rees
- The Alliance for Paired Donation, Maumee, OH, USA
| | - Connie Smith
- The Alliance for Paired Donation, Maumee, OH, USA
| | - Itai Ashlagi
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - Michael A Rees
- Department of Medical Microbiology and Immunology, University of Toledo Medical Center, Toledo, OH, USA.,The Alliance for Paired Donation, Maumee, OH, USA.,Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
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23
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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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24
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Holscher CM, Jackson K, Thomas AG, Haugen CE, DiBrito SR, Covarrubias K, Gentry SE, Ronin M, Waterman AD, Massie AB, Wang JG, Segev DL. Temporal changes in the composition of a large multicenter kidney exchange clearinghouse: Do the hard-to-match accumulate? Am J Transplant 2018; 18:2791-2797. [PMID: 30063811 PMCID: PMC6287934 DOI: 10.1111/ajt.15046] [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: 05/31/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/25/2023]
Abstract
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P = .03), the proportion decreased to 17% by June 2016 (P < .001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P = .02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
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Affiliation(s)
| | - Kyle Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra R. DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karina Covarrubias
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | | | - Amy D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA, USA,Terasaki Research Institute, Los Angeles, CA, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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25
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Abramowicz D, Oberbauer R, Heemann U, Viklicky O, Peruzzi L, Mariat C, Crespo M, Budde K, Oniscu GC. Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board. Nephrol Dial Transplant 2018; 33:1699-1707. [PMID: 29342289 PMCID: PMC6168736 DOI: 10.1093/ndt/gfx365] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
Transplantation medicine is a rapidly evolving field. Keeping afloat of the published literature to offer the best clinical care to our patients is a daunting task. As part of its educational mission, the Descartes advisory board identified seven topics in kidney transplantation where there has been substantial progresses over the last years: kidney allocation within Eurotransplant; kidney exchange strategies; kidney machine perfusion strategies; the changing landscape of anti-human leukocyte antigen (HLA) antibodies; the new immunosuppressive drugs in the pipeline; strategies for immunosuppression minimization; and the continuous enigma of focal segmental glomerular sclerosis recurrence after transplantation. Here, we have summarized the main knowledge and the main challenges of these seven topics with the aim to provide transplant professionals at large with key bullet points to successfully understand these new concepts.
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Affiliation(s)
- Daniel Abramowicz
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
- Department of Nephrology, KH Elisabethinen, Linz, Austria
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, München, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
| | - Licia Peruzzi
- Nephrology and Dialysis Department, Regina Margherita Hospital, Torino, Italy
| | - Christophe Mariat
- Department of Nephrological Intensive Care, University Jean Monnet, Saint Etienne, France
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | - Klemens Budde
- Department of Nephrology, Charité—Universitätsmedizin Berlin, Berlin, Germany
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26
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Kidney Paired Donation and the "Valuable Consideration" Problem: The Experiences of Australia, Canada, and the United States. Transplantation 2018; 101:1996-2002. [PMID: 29633981 DOI: 10.1097/tp.0000000000001778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
As organ donation rates remain unable to meet the needs of individuals waiting for transplants, it is necessary to identify reasons for this shortage and develop solutions to address it. The introduction of kidney paired donation (KPD) programs represents one such innovation that has become a valuable tool in donation systems around the world. Although KPD has been successful in increasing kidney donation and transplantation, there are lingering questions about its legality. Donation through KPD is done in exchange for-and with the expectation of-a reciprocal kidney donation and transplantation. It is this reciprocity that has caused concern about whether KPD complies with existing law. Organ donation systems around the world are almost universally structured to legally prohibit the commercial exchange of organs. Australia, Canada, and the United States have accomplished this goal by prohibiting the exchange of an organ for "valuable consideration," which is a legal term that has not historically been limited to monetary exchange. Whether or not KPD programs violate this legislative prohibition will depend on the specific legislative provision being considered, and the legal system and case law of the particular jurisdiction in question. This article compares the experiences of Australia, Canada, and the United States in determining the legality of KPD and highlights the need for legal clarity and flexibility as donation and transplantation systems continue to evolve.
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27
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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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28
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Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Tenenbaum EM. Swaps and Chains and Vouchers, Oh My!: Evaluating How Saving More Lives Impacts the Equitable Allocation of Live Donor Kidneys. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:67-118. [PMID: 29764323 DOI: 10.1177/0098858818763812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors. It starts with the simplest - direct donation by family members - and ends with voucher donations, a very recent and unique innovation because the donor can donate 20 or more years before the intended recipient is expected to need a kidney. In return for the donation, the intended recipient receives a voucher that can be redeemed for a live kidney when it is needed. Other innovations that are discussed include kidney exchanges and list paired donation, which are used to facilitate donor swaps when donor/recipient pairs have incompatible blood types. The discussion of each new innovation shows how the equity issues build on each other and how, with each new innovation, it becomes progressively harder to find an acceptable balance between utility and justice. The article culminates with an analysis of two recent allocation methods that have the potential to save many additional lives, but also affirmatively harm some patients on the deceased donor waiting list by increasing their waiting time for a life-saving kidney. The article concludes that saving additional lives does not justify harming patients on the waiting list unless that harm can be minimized. It also proposes solutions to minimize the harm so these new innovations can equitably perform their intended function of stimulating additional transplants and extending the lives of many transplant patients.
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Affiliation(s)
- Evelyn M Tenenbaum
- Professor of Law, Albany Law School and Professor of Bioethics, Albany Medical College. Special thanks to Darren O'Connor, David Conti, Timothy Lytton, Nadia Sawicki, Jed Adam Gross, and Bridget Cuccia for their editing suggestions and invaluable comments. I owe everlasting gratitude to my fantastic research assistants Erin Kilmer, Emily Phillips, and Alexandra Newcomb for their tireless research assistance and enormous help in getting this article out the door. This article is dedicated to my sister Judy Tenenbaum, the strongest person I know, to thank her for her consistent support, wonderful sense of humor, and unique ability to give me perspective
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30
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Shah PS, Varyani UT, Wakhare PS, Shinde SG, Ghodela VA, Trivedi VB, Patel MH, Trivedi HL. Seventy-seven kidney paired donation transplantations at a single transplant centre in India led to an increase in living donor kidney transplantations in 2015. Clin Kidney J 2017; 10:709-714. [PMID: 28979784 PMCID: PMC5622902 DOI: 10.1093/ckj/sfx032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/07/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To ascertain the validity of kidney paired donations (KPDs) as an alternative strategy for increasing living donor kidney transplantations (LDKTs) in an LDKT-dominated transplant programme since directed kidney transplantation, ABO-incompatible or crossmatch-positive pairs are not feasible due to costs and infectious complications. METHODS This was a prospective single-centre study of 77 KPD transplantations (25 two-way, 7 three-way and 1 six-way exchange) from 1 January 2015 to 1 January 2016 of 158 registered donor recipient pairs. During this period, a total of 380 kidney transplantations [71 deceased donor kidney transplantations (DDKTs), 309 LDKTs] were performed. The reasons for opting for KPD were ABO incompatibility (n = 45), sensitization (n = 26) and better matching (n = 6). RESULTS KPD matching was facilitated in 62% (n = 98) of transplants. In all, 48.7% (n = 77) of the transplants were completed in 2015, whereas 13.3% (n = 21) of the matched patients were to undergo transplant surgery in early 2016 after getting legal permission. The waiting time for KPD was shorter compared with DDKT. The death-censored graft survival and patient survival were 98.7% (n = 76) and 93.5% (n = 72), respectively. In all, 14.2% (n = 11) of patients had acute rejection. Match rates among sensitized (n = 60) and O group patients (n = 62) were 58.3% (n = 35) and 41.9% (n = 26), respectively. Of these, 43.3% (n = 26) and 29% (n = 18) of transplants were completed and 15% (n = 9) and 12.9% (n = 8), respectively, are waiting for legal permission. CONCLUSIONS LDKT increased by 25% in 1 year in our single-centre KPD programme. Our key to success was the formation of a KPD registry, awareness and active counselling programs and developing a dedicated team.
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Affiliation(s)
- Vivek B. Kute
- Department of Nephrology and 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 Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pankaj R. Shah
- Department of Nephrology and 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
| | - Veena R. Shah
- Department of Anaesthesia, IKDRC-ITS, Ahmedabad, India
| | - Sayyed J. Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Bipin C. Pal
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Priya S. Shah
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Umesh T. Varyani
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pavan S. Wakhare
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Saiprasad G. Shinde
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vijay A. Ghodela
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Varsha B. Trivedi
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohaematology, IKDRC-ITS, Ahmedabad, India
| | - Minaxi H. Patel
- Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohaematology, IKDRC-ITS, Ahmedabad, India
| | - Hargovind L. Trivedi
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
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31
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Ashby VB, Leichtman AB, Rees MA, Song PXK, Bray M, Wang W, Kalbfleisch JD. A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size. Clin J Am Soc Nephrol 2017; 12:1148-1160. [PMID: 28596416 PMCID: PMC5498352 DOI: 10.2215/cjn.09330916] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Outcomes for transplants from living unrelated donors are of particular interest in kidney paired donation (KPD) programs where exchanges can be arranged between incompatible donor-recipient pairs or chains created from nondirected/altruistic donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using Scientific Registry of Transplant Recipients data, we analyzed 232,705 recipients of kidney-alone transplants from 1998 to 2012. Graft failure rates were estimated using Cox models for recipients of kidney transplants from living unrelated, living related, and deceased donors. Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight. RESULTS The dependence of graft failure on increasing donor age was less pronounced for living-donor than for deceased-donor transplants. Male donor-to-male recipient transplants had lower graft failure, particularly better than female to male (5%-13% lower risk). HLA mismatch was important in all donor types. Obesity of both the recipient (8%-18% higher risk) and donor (5%-11% higher risk) was associated with higher graft loss, as were donor-recipient weight ratios of <75%, compared with transplants where both parties were of similar weight (9%-12% higher risk). These models are used to create a calculator of estimated graft survival for living donors. CONCLUSIONS This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors. It may also help inform candidates with compatible donors on the advisability of joining a KPD program.
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Affiliation(s)
- Valarie B. Ashby
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Alan B. Leichtman
- Arbor Research Collaborative for Health, Division of Nephrology, University of Michigan, Ann Arbor, Michigan; and
| | - Michael A. Rees
- Departments of Urology and Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Peter X.-K. Song
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mathieu Bray
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Wen Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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32
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Shah PS, Modi MP, Butala BP, Wakhare PS, Varyani UT, Shinde SG, Ghodela VA, Kasat GS, Patil MV, Patel JC, Kumar DP, Trivedi VB, Patel MH, Trivedi HL. Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study. Transpl Int 2017; 30:679-688. [PMID: 28319288 DOI: 10.1111/tri.12956] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022]
Abstract
In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n = 222), positive cross-match (n = 59) and better matching (n = 19). A total of 124 two-way (n = 248), 14 three-way (n = 42), one four-way (n = 4) and one six-way exchange (n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n = 288) and 83.3% (n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist.
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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
| | - 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
| | - Pranjal R Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Veena R Shah
- Department of Anesthesia, IKDRC-ITS, Ahmedabad, India
| | - Sayyed J Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Bipin C Pal
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Priyadarshini S 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
| | | | | | - Pavan S Wakhare
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Umesh T Varyani
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Saiprasad G Shinde
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Vijay A Ghodela
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Govind S Kasat
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Mayur V Patil
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Jaydeep C 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
| | - Deepk P Kumar
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India
| | - Varsha B Trivedi
- Laboratory Medicine, Transfusion Services and Immunohematology, Department of Pathology, IKDRC-ITS, Ahmedabad, India
| | - Minaxi H Patel
- Laboratory Medicine, Transfusion Services and Immunohematology, Department of Pathology, IKDRC-ITS, Ahmedabad, India
| | - 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, India
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33
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Weng FL, Grogan T, Patel AM, Mulgaonkar S, Morgievich MM. Characteristics of compatible pair participants in kidney paired donation at a single center. Clin Transplant 2017; 31:10.1111/ctr.12978. [PMID: 28342273 PMCID: PMC5831242 DOI: 10.1111/ctr.12978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 12/16/2022]
Abstract
Compatible pairs of living kidney donors and their intended recipients can enter into kidney paired donation (KPD) and facilitate additional living donor kidney transplants (LDKTs). We examined 11 compatible pairs (the intended recipients and their intended, compatible donors) who participated in KPD, along with the recipients' 11 matched, exchange donors. The 11 pairs participated in 10 separate exchanges (three were multicenter exchanges) that included 33 total LDKTs (22 additional LDKTs). All the intended donors were blood group O and female, with a mean living kidney donor profile index (LKDPI) of 27.6 (SD 16.8). The matched donors had a mean LKDPI of 9.4 (SD 31.7). Compatible pairs entered KPD for altruistic reasons (N=2) or due to mismatch of age (N=7) or body/kidney size (N=2) between the recipient and intended donor. In four cases, retrospective calculation of the LKDPI revealed that the matched donor had a higher LKDPI than the intended donor. Of the 22 recipients of LDKTs enabled by the compatible pairs, three were highly sensitized, with PRA >80%. In conclusion, most compatible pairs entered into KPD so that the recipient could receive a LDKT transplant from a donor whose age or body/kidney size were more favorable to post-transplant outcomes.
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Affiliation(s)
- Francis L. Weng
- Renal & Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA
- Rutgers School of Public Health, Department of Epidemiology, Piscataway, NJ, USA
| | - Tracy Grogan
- Renal & Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Anup M. Patel
- Renal & Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Shamkant Mulgaonkar
- Renal & Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Marie M. Morgievich
- Renal & Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA
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34
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Kute VB, Patel HV, Shah PR, Modi PR, Shah VR, Rizvi SJ, Pal BC, Modi MP, Shah PS, Varyani UT, Wakhare PS, Shinde SG, Ghodela VA, Patel MH, Trivedi VB, Trivedi HL. Past, present and future of kidney paired donation transplantation in India. World J Transplant 2017; 7:134-143. [PMID: 28507916 PMCID: PMC5409913 DOI: 10.5500/wjt.v7.i2.134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/01/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, non-simultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor pool. In absence of national kidney paired donation program, a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HLA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. This review assists in the development of similar programs in other developing countries.
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35
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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36
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Bentall A, R Barnett AN, Braitch M, Kessaris N, McKane W, Newstead C, McHaffie G, Brown A, Griffin S, Mamode N, Briggs D, Ball S. Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO-incompatible kidney transplantation in the United Kingdom. Transfusion 2016; 56:2668-2679. [PMID: 27562458 DOI: 10.1111/trf.13770] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/04/2016] [Accepted: 07/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND ABO blood group-incompatible kidney transplantation (ABOiKTx) outcomes are good, but complications are more common than in conventional transplantation. Regimens that use extracorporeal antibody removal therapy (EART) and enhanced immunosuppression are guided by titration of ABO blood group antibodies (using hemagglutination [HA] dilution assays), and these assays vary significantly in performance between centers. This study aims to describe the differences in titer measurement and the effect on clinical practice and outcomes. STUDY DESIGN AND METHODS This multicentre, prospective cohort study of 100 ABOiKTx recipients assessed treatment and outcome data, including HA assay results measured retrospectively in a single central laboratory. RESULTS Patient and allograft survival at 1 year was 99% and 94%, respectively. There were significant differences in the number of pretransplantation EART sessions in centers undertaking plasma exchange (PEx), compared with immunoadsorption (IA) (median, 6 vs. 4 sessions; p = 0.007). The pre-EART HA titer in both groups was the same when centrally assayed. The local HA assay used to guide treatment yielded significantly higher titers in centers undertaking PEx compared with IA (median, 128 vs. 32; p < 0.005). Patients undergoing PEx rather than IA were significantly more likely to suffer postoperative hematoma (12.9% vs. 1.8%; p = 0.05) or any perioperative collection requiring drainage (19.4% vs. 3.6%; p = 0.02). CONCLUSION The colinearity of HA assay sensitivity with the receipt of PEx and EART limits some conclusions regarding the likely direction of causation. However, the association of differences in clinical practice with recognized perioperative complications of ABOiKTx identifies targets for further investigation and quality improvement.
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Affiliation(s)
- Andrew Bentall
- Department of Renal Medicine, Queen Elizabeth Hospital.,School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - A Nicholas R Barnett
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Manjit Braitch
- School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Nicos Kessaris
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Will McKane
- Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Chas Newstead
- Department of Nephrology and Transplantation, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Gavin McHaffie
- Department of Nephrology and Transplantation, Nottingham, United Kingdom
| | - Alison Brown
- Department of Nephrology and Transplantation, Newcastle, United Kingdom
| | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy's and St Thomas' Hospital, London, United Kingdom
| | - David Briggs
- Department of Histocompatibility and Immunogenetics, National Health Service Blood and Transplant, Birmingham Centre, Birmingham, United Kingdom
| | - Simon Ball
- Department of Renal Medicine, Queen Elizabeth Hospital.,School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
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37
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Milner J, Melcher ML, Lee B, Veale J, Ronin M, D'Alessandro T, Hil G, Fry PC, Shannon PW. HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange. Transplant Direct 2016; 2:e85. [PMID: 27830179 PMCID: PMC5087568 DOI: 10.1097/txd.0000000000000597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/08/2016] [Accepted: 04/22/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We sought to identify donor characteristics influencing long-term graft survival, expressed by a novel measure, kidney life years (KLYs), in living donor kidney transplantation (LDKT). METHODS Cox and multiple regression analyses were applied to data from the Scientific Registry for Transplant Research from 1987 to 2015. Dependent variable was KLYs. RESULTS Living donor kidney transplantation (129 273) were performed from 1987 to 2013 in the United States. To allow sufficient time to assess long-term results, outcomes of LDKTs between 1987 and 2001 were analyzed. After excluding cases where a patient died with a functioning graft (8301) or those missing HLA data (9), 40 371 cases were analyzed. Of 18 independent variables, the focus became the 4 variables that were the most statistically and clinically significant in that they are potentially modifiable in donor selection (P <0.0001; ie, HLA match points, donor sex, donor biological sibling and donor age). HLA match points had the strongest relationship with KLYs, was associated with the greatest tendency toward graft longevity on Cox regression, and had the largest increase in KLYs (2.0 year increase per 50 antigen Match Points) based on multiple regression. CONCLUSIONS In cases when a patient has multiple potential donors, such as through paired exchange, graft life might be extended when a donor with favorable matching characteristics is selected.
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Affiliation(s)
- John Milner
- Northshore University Health System, Chicago, IL
| | | | - Brian Lee
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Jeff Veale
- Department of Urology, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Garet Hil
- The National Kidney Registry, Babylon, NY
| | - Phillip C. Fry
- College of Business and Economics, Boise State University, Boise, ID
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38
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Melcher ML, Roberts JP, Leichtman AB, Roth AE, Rees MA. Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains. Am J Transplant 2016; 16:1367-70. [PMID: 26833680 PMCID: PMC4844828 DOI: 10.1111/ajt.13740] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 01/25/2023]
Abstract
We propose that some deceased donor (DD) kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor (LD) kidney transplants to address, in part, the huge disparity between patients on the DD kidney waitlist and available donors. The use of DD kidneys for this purpose would benefit waitlisted candidates in that most patients enrolled in kidney paired donation (KPD) systems are also waitlisted for a DD kidney transplant, and receiving a kidney through the mechanism of KPD will decrease pressure on the DD pool. In addition, a LD kidney usually provides survival potential equal or superior to that of DD kidneys. If KPD chains that are initiated by a DD can end in a donation of an LD kidney to a candidate on the DD waitlist, the quality of the kidney allocated to a waitlisted patient is likely to be improved. We hypothesize that a pilot program would show a positive impact on patients of all ethnicities and blood types.
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Affiliation(s)
| | - John P. Roberts
- Surgery, University of California at San Francisco, San Francisco, CA
| | | | | | - Michael A. Rees
- Urology, University of Toledo Medical Center, Toledo, OH,Alliance for Paired Donation, Maumee, OH
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39
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Tenenbaum EM. BARTERING FOR A COMPATIBLE KIDNEY USING YOUR INCOMPATIBLE, LIVE KIDNEY DONOR: LEGAL AND ETHICAL ISSUES RELATED TO KIDNEY CHAINS. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:129-169. [PMID: 27263265 DOI: 10.1177/0098858816644719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethicalframeworks, raising potential barriers to their full implementation. Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor ("NEAD") kidney chains--which consist of a sequence of donations by incompatible donors--to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration.
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40
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Bray M, Wang W, Song PXK, Leichtman AB, Rees MA, Ashby VB, Eikstadt R, Goulding A, Kalbfleisch JD. Planning for Uncertainty and Fallbacks Can Increase the Number of Transplants in a Kidney-Paired Donation Program. Am J Transplant 2015; 15:2636-45. [PMID: 26372837 PMCID: PMC5559873 DOI: 10.1111/ajt.13413] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/05/2015] [Accepted: 04/23/2015] [Indexed: 01/25/2023]
Abstract
A kidney-paired donation (KPD) pool consists of transplant candidates and their incompatible donors, along with nondirected donors (NDDs). In a match run, exchanges are arranged among pairs in the pool via cycles, as well as chains created from NDDs. A problem of importance is how to arrange cycles and chains to optimize the number of transplants. We outline and examine, through example and by simulation, four schemes for selecting potential matches in a realistic model of a KPD system; proposed schemes take account of probabilities that chosen transplants may not be completed as well as allowing for contingency plans when the optimal solution fails. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Donation, the simulations extend over 8 match runs, with 30 pairs and 1 NDD added between each run. Schemes that incorporate uncertainties and fallbacks into the selection process yield substantially more transplants on average, increasing the number of transplants by as much as 40% compared to a standard selection scheme. The gain depends on the degree of uncertainty in the system. The proposed approaches can be easily implemented and provide substantial advantages over current KPD matching algorithms.
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Affiliation(s)
- M Bray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - W Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; 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
| | - A. B. Leichtman
- University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI,University of Michigan, Department of Medicine, Ann Arbor MI
| | - M. A. Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH,Alliance for Paired Donation, Inc., Maumee, OH
| | - V. B. Ashby
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - R. Eikstadt
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - A. Goulding
- University of Michigan, School of Information, 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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41
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Varyani U, Kute V, Patel H, Shah P, Vanikar A, Modi P, Shah V, Wakhare P, Shinde S, Godhela V, Shah P, Trivedi V, Trivedi H. Participation of compatible donor to improve HLA matching can increase kidney transplant rate of O blood group patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cqn.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Mannon RB. Organ-specific features in clinical transplantation. Transpl Immunol 2015. [DOI: 10.1002/9781119072997.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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43
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Martin DE, White SL. Financial Incentives for Living Kidney Donors: Are They Necessary? Am J Kidney Dis 2015; 66:389-95. [DOI: 10.1053/j.ajkd.2015.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/06/2015] [Indexed: 12/17/2022]
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44
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Cruzado JM, Manonelles A, Vila H, Melilli E, Sala N, Bestard O, Torras J, Tebé C, Riera L, Grinyó JM. Residual urinary volume is a risk factor for primary nonfunction in kidney transplantation. Transpl Int 2015; 28:1276-82. [DOI: 10.1111/tri.12625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/26/2015] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Josep M. Cruzado
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Anna Manonelles
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Helena Vila
- Urology Department; Hospital Universitari de Bellvitge; L'Hospitalet de Llobregat Spain
| | - Edoardo Melilli
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Neus Sala
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Oriol Bestard
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Joan Torras
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Cristian Tebé
- Statistical Advisory Service; Bellvitge Biomedical Institute-IDIBELL; Faculty of Medicine and Health Sciences; University Rovira i Virgili; L'Hospitalet de Llobregat Spain
| | - Lluís Riera
- Urology Department; Hospital Universitari de Bellvitge; L'Hospitalet de Llobregat Spain
| | - Josep M. Grinyó
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
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Cuffy MC, Ratner LE, Siegler M, Woodle ES. Equipoise: ethical, scientific, and clinical trial design considerations for compatible pair participation in kidney exchange programs. Am J Transplant 2015; 15:1484-9. [PMID: 25773372 DOI: 10.1111/ajt.13218] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/02/2015] [Accepted: 01/03/2015] [Indexed: 01/25/2023]
Abstract
Compatible living donor/recipient pair participation (CPP) in kidney exchange (KE) transplantation may substantially increase transplant volumes and significantly mitigate the O blood group donor shortage in KE. Initial ethical analysis did not support CPP for two primary reasons: (1) KE would be "unbalanced," and (2) the possibility of undue influence experienced by the compatible pair living donor. Recent developments with CPP (modeling studies and small clinical experiences), have demonstrated substantial potential for increasing KE volumes. This encouraged us to reconsider initial ethical concerns, with a focus on the potential for a design of a prospective CPP clinical trial. This ethical reconsideration led us to conclude that the concept of unbalanced kidney exchanges (manifested primarily by differential benefit between compatible and incompatible pairs) is no longer as clear cut as originally conceived. In addition, application of two concepts substantially diminishes ethical concerns including: (1) "quasi-compatible" pairs, and (2) a priori definition of mitigating factors. We conclude that genuine uncertainty exists regarding whether kidney exchange is best performed with or without compatible pair participation and that a clinical trial is therefore warranted.
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Affiliation(s)
- M C Cuffy
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - L E Ratner
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - M Siegler
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - E S Woodle
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Transplant professionals' proposals for the implementation of an altruistic unbalanced paired kidney exchange program. Transplantation 2015; 98:754-9. [PMID: 24873778 DOI: 10.1097/tp.0000000000000127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kidney recipients in the O blood group are at a disadvantage in kidney exchange programs (KEPs) because they can only receive an organ from O blood group donors. A way to remedy this unfair situation is through altruistic unbalanced paired kidney exchange (AUPKE) where a compatible pair (CP) consisting of an O donor and a non-O recipient is invited to participate in a KEP. There is no established AUPKE program in Canada. The aim of this study was to gather transplant professionals' views on the conditions necessary for the implementation of an AUPKE program. METHODS Nineteen Canadian transplant professionals took part in semistructured interviews. The content of these interviews was analyzed using a qualitative data analysis method. RESULTS Respondents' recommendations focused on the following: (i) the logistics of AUPKE (e.g., not delaying the transplantation for the CP, retrieving organs locally, providing a good quality organ to the CP, and maintaining anonymity); (ii) the transplantation teams (e.g., establishing a consensus among members and ensuring sufficient resources); (iii) information provided to CPs; and (iv) research (e.g., looking into all transplant options for O recipients, studying all potential impacts of KEPs and AUPKE). CONCLUSION The respondents in our study made the following recommendations for the implementation of an AUPKE program: (i) CPs should not be disadvantaged, (ii) measures should be taken to ensure that all transplant team members agree to participate and that there are sufficient resources for implementation, (iii) comprehensive information should be provided to the CP, and (iv) further research is needed on AUPKE.
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Rodrigue JR, Leishman R, Vishnevsky T, Evenson A, Mandelbrot DA. Concerns of ABO incompatible and crossmatch-positive potential donors and recipients about participating in kidney exchanges. Clin Transplant 2015; 29:233-41. [PMID: 25581082 DOI: 10.1111/ctr.12509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 01/29/2023]
Abstract
Kidney paired exchanges (KPEs) have increased, yet are still underutilized. This study aimed to develop tools for assessing KPE concerns, identify predictors of KPE concerns, and describe common KPE concerns among potential living donors (LDs) and intended recipients. Incompatible former potential LDs (n = 135) and intended recipients (n = 83) retrospectively completed questionnaires to assess KPE concerns. Healthcare system distrust also was assessed. A minority (n = 48 or 36.5% of potential LDs; n = 25 or 30.1% of intended recipients) had pursued KPE participation. Of those who pursued KPE participation, 11 (22.9%) and 6 (24.0%) completed KPE donation or transplantation, respectively. The questionnaires for potential LDs and recipients showed good internal consistency and preliminary convergent validity. LDs and patients less willing to pursue KPE reported more KPE concerns. Common KPE concerns for both potential LDs and recipients were related to perceived Distrust/Inequity and Inconvenience/Cost. Multivariate predictors of more KPE concerns were as follows: male gender (t = 4.5, p < 0.001) and more healthcare system distrust (t = 2.5, p = 0.01) for potential LDs; black race (t = 2.1, p = 0.04) and more healthcare system distrust (t = 2.3, p = 0.03) for intended recipients. These findings underscore the importance of addressing concerns potential LDs and patients have about KPE if the true potential of KPE is to be realized.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Trasplante renal de donante vivo: “una mirada global”. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation 2014; 98:54-65. [PMID: 24978035 DOI: 10.1097/tp.0000000000000029] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Descriptions of the sequelae of ABO-incompatible (ABOi) kidney transplantation are limited to single-center reports, which may lack power to detect important effects. METHODS We examined U.S. Renal Data System registry data to study associations of ABOi live-donor kidney transplantation with clinical complications in a national cohort. Among 14,041 Medicare-insured transplants in 2000 to 2007, 119 non-donor-A2 ABOi transplants were identified. A2-incompatible (n=35) transplants were categorized separately. Infection and hemorrhage events were identified by diagnosis codes on billing claims. Associations of ABO incompatibility with complications were assessed by multivariate Cox regression. RESULTS Recipients of ABOi transplants experienced significantly (P<0.05) higher incidence of wound infections (12.7% vs. 7.3%), pneumonia (7.6% vs. 3.8%), and urinary tract infections (UTIs) or pyelonephritis (24.5% vs. 15.3%) in the first 90 days compared with ABO-compatible recipients. In adjusted models, ABO incompatibility was associated with twice the risk of pneumonia (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI], 1.14-4.33) and 56% higher risk of UTIs or pyelonephritis (aHR, 1.56; 95% CI, 1.05-2.30) in the first 90 posttransplantation days, and 3.5 times the relative risk of wound infections in days 91 to 365 (aHR, 3.55; 95% CI, 1.92-6.57). ABOi recipients, 19% of whom underwent pre- or peritransplant splenectomy, experienced twice the adjusted risk of early hemorrhage (aHR, 1.96; 95% CI, 1.19-3.24). A2-incompatible transplantation was associated only with early risk of UTIs or pyelonephritis. CONCLUSION ABOi transplantation offers patients with potential live donors an additional transplant option but with higher risks of infectious and hemorrhagic complications. Awareness of these complications may help improve protocols for the management of ABOi transplantation.
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Baxter-Lowe LA, Cecka M, Kamoun M, Sinacore J, Melcher ML. Center-defined unacceptable HLA antigens facilitate transplants for sensitized patients in a multi-center kidney exchange program. Am J Transplant 2014; 14:1592-8. [PMID: 24934640 DOI: 10.1111/ajt.12734] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 01/25/2023]
Abstract
Multi-center kidney paired donation (KPD) is an exciting new transplant option that has not yet approached its full potential. One barrier to progress is accurate virtual crossmatching for KPD waitlists with many highly sensitized patients. Virtual crossmatch results from a large multi-center consortium, the National Kidney Registry (NKR), were analyzed to determine the effectiveness of flexible center-specific criteria for virtual crossmatching. Approximately two-thirds of the patients on the NKR waitlist are highly sensitized (>80% CPRA). These patients have antibodies against HLA-A (63%), HLA-B (66%), HLA-C (41%), HLA-DRB1 (60%), HLA-DRB3/4/5 (18-22%), HLA-DQB1 (54%) and HLA-DPB1 (26%). With donors typed for these loci before activation, 91% of virtual crossmatches accurately predicted an acceptable cell-based donor crossmatch. Failed virtual crossmatches were attributed to equivocal virtual crossmatches (46%), changes in HLA antibodies (21%), antibodies against HLA-DQA (6%), transcription errors (6%), suspected non-HLA antibodies (5%), allele-specific antibodies (1%) and unknown causes (15%). Some failed crossmatches could be prevented by modifiable factors such as more frequent assessment of HLA antibodies, DQA1 typing of donors and auditing data entry. Importantly, when transplant centers have flexibility to define crossmatch criteria, it is currently feasible to use virtual crossmatching for highly sensitized patients to reliably predict acceptable cell-based crossmatches.
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Affiliation(s)
- L A Baxter-Lowe
- HLA Laboratory, Children's Hospital Los Angeles, Los Angeles, CA
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