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Kute VB, Fleetwood VA, Chauhan S, Meshram HS, Caliskan Y, Varma C, Yazıcı H, Oto ÖA, Lentine KL. Kidney paired donation in developing countries: A global perspective. CURRENT TRANSPLANTATION REPORTS 2023; 10:117-125. [PMID: 37720696 PMCID: PMC10501157 DOI: 10.1007/s40472-023-00401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Purpose of review We review the key principles of kidney paired donation (KPD) and discuss the status and unique considerations for KPD in developing countries. Recent findings Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices. Summary KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need world-wide.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Vidya A. Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Chintalapati Varma
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Halil Yazıcı
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Özgür Akın Oto
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Abstract
Kidney failure is among the leading causes of death worldwide, and the best treatment is transplantation. However, transplants are in short supply because of shortfalls of transplantable organs and of finances. In the United States and some other countries, kidney exchange chains have emerged as a way to increase the number of transplants; patients who have a willing donor but cannot receive that donor’s kidney can each receive a compatible kidney from another patient’s intended donor. Such programs are much better developed within the borders of wealthy countries, which is of little help to patients in countries with limited kidney transplantation or exchange. This paper proposes and analyzes a way to extend kidney exchange chains to share the benefits globally. Kidney failure is a worldwide scourge, made more lethal by the shortage of transplants. We propose a way to organize kidney exchange chains internationally between middle-income countries with financial barriers to transplantation and high-income countries with many hard to match patients and patient–donor pairs facing lengthy dialysis. The proposal involves chains of exchange that begin in the middle-income country and end in the high-income country. We also propose a way of financing such chains using savings to US health care payers.
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Roth AE, Marino IR, Ekwenna O, Dunn TB, Paloyo SR, Tan M, Correa-Rotter R, Kuhr CS, Marsh CL, Ortiz J, Testa G, Sindhwani P, Segev DL, Rogers J, Punch JD, Forbes RC, Zimmerman MA, Ellis MJ, Rege A, Basagoitia L, Krawiec KD, Rees MA. Global kidney exchange should expand wisely. Transpl Int 2021; 33:985-988. [PMID: 32430941 DOI: 10.1111/tri.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Ty B Dunn
- University of Pennsylvania, Philadelphia, PA, USA
| | - Siegfredo R Paloyo
- Philippine General Hospital, University of the Philippines, Manila, Philippines.,St. Luke's Medical Center, Manila, Philippines
| | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | - Jeffrey Rogers
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | | | | | | | | | - Aparna Rege
- Duke University Medical Center, Durham, NC, USA
| | - Laura Basagoitia
- General Regional Hospital No 1, Dr. Carlos Macgregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Michael A Rees
- University of Toledo, Toledo, OH, USA.,Alliance for Paired Kidney Donation, Perrysburg, OH, USA
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Salvadori M, Tsalouchos A. Current protocols and outcomes of ABO-incompatible kidney transplantation. World J Transplant 2020; 10:191-205. [PMID: 32844095 PMCID: PMC7416363 DOI: 10.5500/wjt.v10.i7.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
One of the principal obstacles in transplantation from living donors is that approximately 30% are immunologically incompatible because of the presence in the recipient of antibodies directed against the human leukocyte antigen system of the donor or because of the incompatibility of the ABO system. The aim of this review is to describe the more recent data from the literature on the different protocols used and the clinical outcomes of ABO-incompatible kidney transplantation. Two different strategies are used to overcome these barriers: desensitization of the recipient to remove the antibodies and to prevent their rebound after transplantation and the exchange of organs between two or more pairs. The largest part of this review is dedicated to describing the techniques of desensitization. Even if the first reports of successful renal transplantation between ABO-incompatible pairs have been published by 1980, the number of ABO-incompatible transplants increased substantially in this century because of our improved knowledge of the immune system and the availability of new drugs. Rituximab has substantially replaced splenectomy. The technique of apheresis has improved and more recently a tailored desensitization proved to be the more efficient strategy avoiding an excess of immunosuppression with the related side effects. Recent reports document outcomes for such transplantation similar to the outcomes of standard transplantation.
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Affiliation(s)
- Maurizio Salvadori
- Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy
| | - Aris Tsalouchos
- Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Pescia 51017, Italy
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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: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [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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Tafulo S, Malheiro J, Dias L, Lobato L, Ramalhete L, Martinho A, Bolotinha C, Costa R, Ivo M. Improving HLA matching in living donor kidney transplantation using kidney paired exchange program. Transpl Immunol 2020; 62:101317. [PMID: 32634478 DOI: 10.1016/j.trim.2020.101317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The inclusion of compatible pairs within kidney paired exchange programs has been described as a way to enhance these programs. Improved immunological matching for the recipient in compatible pair has been described to be a possible benefit. METHODS The main purpose of our study was to determine if the introduction of compatible pairs in the Portuguese kidney paired exchange program would result in a better match for these patients, but also to assess if this strategy would increase the number of incompatible pairs with a possible match. We included 17 compatible pairs in kidney paired exchange pool of 35 pairs and performed an in-silico simulation determining HLA eplet mismatch load between the co-registered and matched pairs using HLA MatchMaker, version 3.0. RESULTS Our study showed that the inclusion of fully HLA-A, -B, -DR mismatched compatible pairs within the national Portuguese KEP increased matched rate within ICP (0.71%) and improved HLA eplet matching within compatible pairs. 16 of 17 (94.12%) of the CP obtained one or more transplants possibilities and 13 (81.25%) would have been transplanted with significantly lower HLA class I and class II total and antibody-verified eplet mismatch load (83.9 ± 16.9 vs. 59.8 ± 12.2, P = .002 and 30.1 ± 5.5 vs. 21.2 ± 3.0, P = .003, respectively). CONCLUSIONS This strategy is a viable alternative for compatible pairs seeking a better matched kidney and Portuguese KEP program should allow them this possibility.
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Affiliation(s)
- Sandra Tafulo
- Blood and Transplantation Center of Porto, Instituto Português do Sangue e da Transplantação, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal.
| | - Jorge Malheiro
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Leonídio Dias
- Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Luísa Lobato
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal
| | - Luís Ramalhete
- Blood and Transplantation Center of Lisbon, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - António Martinho
- Blood and Transplantation Center of Coimbra, Instituto Português do Sangue e da Transplantação, Coimbra, Portugal
| | - Catarina Bolotinha
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - Rita Costa
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
| | - Margarida Ivo
- National Transplantation Coordination, Instituto Português do Sangue e da Transplantação, Lisbon, Portugal
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Lo AL, Sonnenberg EM, Abt PL. Evolving swaps in transplantation: global exchange, vouchers, liver, and trans-organ paired exchange. Curr Opin Organ Transplant 2019; 24:161-166. [PMID: 30730354 PMCID: PMC6759363 DOI: 10.1097/mot.0000000000000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand the scope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations. RECENT FINDINGS This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs ('vouchers') and for liver transplantation, liver paired exchange. Lastly, this review considers trans-organ exchange. We explore the conceptual framework of the exchange, current status, benefits, and concerns for implementation among each of these evolving pathways. SUMMARY Through highlighting novel mechanisms in organ exchange, greater awareness, discussion, or support can occur to create more avenues for transplantation. These innovative mechanisms require regulations and safeguards for donors to ensure informed consent, and proper follow-up is maintained.
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Affiliation(s)
- Alexis L. Lo
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Elizabeth M. Sonnenberg
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA
| | - Peter L. Abt
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA
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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: 2.7] [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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Bozek DN, Dunn TB, Kuhr CS, Marsh CL, Rogers J, Rees SE, Basagoitia L, Brunner RJ, Roth AE, Ekwenna O, Fumo DE, Krawiec KD, Kopke JE, Sindhwani P, Ortiz J, Tan M, Paloyo SR, Punch JD, Rees MA. Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up. Eur Urol Focus 2018; 4:190-197. [DOI: 10.1016/j.euf.2018.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 11/15/2022]
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Roth AE, Krawiec KD, Paloyo S, Ekwenna O, Marsh CL, Wenig AJ, Dunn TB, Rees MA. People should not be banned from transplantation only because of their country of origin. Am J Transplant 2017; 17:2747-2748. [PMID: 28862804 DOI: 10.1111/ajt.14485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | | | - Siegfredo Paloyo
- Department of Surgery, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Obi Ekwenna
- Department of Urology, University of Toledo, Toledo, OH, USA
| | - Christopher L Marsh
- Scripps Clinic, Scripps Center for Organ and Cell Transplant, La Jolla, CA, USA
| | | | - Ty B Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael A Rees
- Department of Urology, University of Toledo, Toledo, OH, USA.,Alliance for Paired Donation, Perrysburg, OH, USA
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