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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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Cozzi M, Donato P, Ugolini G, Nguefouet Momo RE, Nacchia F, Ballarini Z, Piccoli P, Cantini M, Caletti C, Andreola S, Gandini G, Gambaro G, Boschiero L. Outcomes in AB0 Incompatible Living Donor Kidney Transplantation: A Case – Control Study. Front Med (Lausanne) 2022; 9:932171. [PMID: 35935799 PMCID: PMC9353324 DOI: 10.3389/fmed.2022.932171] [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: 04/29/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients waiting for a kidney transplant by far exceed available organs. AB0 incompatible living donor kidney transplantation (AB0i LDKT) represents an additional therapeutic strategy, but with higher risk for complications. We aimed at evaluating outcomes of AB0i LDKTs compared to compatible (AB0c) controls at our Institution.MethodsRetrospective matched case – control study (1:2) comparing AB0i vs. AB0c LDKTs from March 2012 to September 2021. Considered outcomes: graft function, acute rejection, sepsis, CMV infection, BK virus reactivation, death-censored graft survival, patient survival.ResultsSeventeen AB0i LDKTs matched to 34 AB0c controls. We found excellent graft function, comparable in the two groups, at all considered intervals, with an eGFR (ml/min/1.73 m2) of 67 vs. 66 at 1 year (p = 0.41), 63 vs. 64 at 3 years (p = 0.53). AB0i recipients had a statistically significant higher incidence of acute rejection, acute antibody-mediated rejection and sepsis within 30 days (p = 0.016; p = 0.02; p = 0.001), 1 year (p = 0.012; p = 0.02; p = 0.0004) and 3 years (p = 0.004; p = 0.006; p = 0.012) after surgery. There was no difference in CMV infection, BK virus reactivation, death-censored graft survival between the two groups. Patient survival was inferior in AB0i group at 1 and 3 years (88.2 vs. 100%; log-rank p = 0.03) due to early death for opportunistic infections. AB0i LDKTs spent longer time on dialysis (p = 0.04) and 82.3 vs. 38.3% controls had blood group 0 (p = 0.003).ConclusionsAB0i LDKT is an effective therapeutic strategy with graft function and survival comparable to AB0c LDKTs, despite higher rates of acute rejection and sepsis. It is an additional opportunity for patients with less chances of being transplanted, as blood group 0 individuals.
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Affiliation(s)
- Martina Cozzi
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Martina Cozzi
| | - Paola Donato
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Gabriele Ugolini
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | | | - Francesco Nacchia
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Zeno Ballarini
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
| | - Pierluigi Piccoli
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Maurizio Cantini
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Chiara Caletti
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Andreola
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Giorgio Gandini
- Transfusion Medicine Unit, Department of Pathology and Diagnostic Services, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Gambaro
- Nephrology Postgraduate School, Department of Medicine, University of Verona, Verona, Italy
- Renal Unit, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Luigino Boschiero
- Kidney Transplant Center, Department of Surgical Sciences, University and Hospital Trust of Verona, Verona, Italy
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Jackson KR, Segev DL. Rethinking incompatibility in kidney transplantation. Am J Transplant 2022; 22:1031-1036. [PMID: 34464500 DOI: 10.1111/ajt.16826] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 01/25/2023]
Abstract
Donor/recipient incompatibility in kidney transplantation classically refers to ABO/HLA-incompatibility. Kidney paired donation (KPD) was historically established to circumvent ABO/HLA-incompatibility, with the goal of identifying ABO/HLA-compatible matches. However, there is a broad range of donor factors known to impact recipient outcomes beyond ABO/HLA-incompatibility, such as age and weight, and quantitative tools are now available to empirically compare potential living donors across many of these factors, such as the living donor kidney donor profile index (LKDPI). Moreover, the detrimental impact of mismatch at other HLA antigens (such as DQ) and epitope mismatching on posttransplant outcomes has become increasingly recognized. Thus, it is time for a new paradigm of incompatibility that considers all of these risks factors together in assessing donor/recipient compatibility and the potential utility for KPD. Under this new paradigm of incompatibility, we show how the LKDPI and other tools can be used to identify donor/recipient incompatibilities that could be improved through KPD, even for those with a traditionally "compatible" living donor.
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Affiliation(s)
- Kyle R Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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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Verbesey J, Thomas AG, Ronin M, Beaumont J, Waterman A, Segev DL, Flechner SM, Cooper M. Early graft losses in paired kidney exchange: Experience from 10 years of the National Kidney Registry. Am J Transplant 2020; 20:1393-1401. [PMID: 31922651 PMCID: PMC7183872 DOI: 10.1111/ajt.15778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/03/2019] [Accepted: 12/30/2019] [Indexed: 01/25/2023]
Abstract
Cooperative kidney paired donation (KPD) networks account for an increasing proportion of all living donor kidney transplants in the United States. There are sparse data on the rate of primary nonfunction (PNF) losses and their consequences within KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of transplantation, and graft losses in the first-year posttransplant and assessed potential risk factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 (0.5%) with PNF. When compared to functioning grafts, there were no clinically significant differences in blood type compatibility, degree of HLA mismatch, number of veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and development of antibody-mediated rejection (AMR). Given the low rate of PNF, the NKR created a policy to allocate chain-end kidneys to recipients with PNF following event review and attributable to surgical issues of donor nephrectomy. It is expected that demonstration of low incidence of poor early graft outcomes and the presence of a "safety net" would further encourage program participation in national KPD.
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Affiliation(s)
| | - Alvin G. Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Amy Waterman
- Terasaki Research Institute, Los Angeles, CA
- Department of Nephrology, University of California, Los Angeles, CA
| | - 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
- Scientific Registry of Transplant Recipients, Minnesota, MN
| | - Stuart M. Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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