Paired Donation Improves Kidney Transplantation Rate- A Single Centre One Year Experience of 56 Kidney Paired Donations.

Abstract

Background:Because access to transplantation with HLA-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD)promises hope to a growing number of end stage renal disease (ESRD) patients. KPD is feasible for any center performing living donor renal transplantation (LDRT). Materials and methods: We present a government and Institutional Ethical Review Board approved study of 56 end stage renal disease (ESRD) patients [25 two-way and 2 three-way pairs] who consented to participate in KPD transplantation at our center in 2013. They were performed to avoid blood group incompatibility (n=52) or positive cross-match (n=4). All patients had anatomic, functional and immunologically comparable donors. Patient ABO type was A (n=24), B (n=22), AB (n=2) and O (n=8). Donor ABO blood group type was A (n=23), B (n=20), AB (n=2) and O (n=11). Results: Commonest original disease leading to ESRD was hypertension (n=23), chronic glomerulonephritis (n=12) and diabetic nephropathy (n=4). Laparoscopic donor nephrectomy was performed in 54 donors. The waiting time in KPD is short(less than 3 months) as compared to deceased donor transplantation (30 months). Median warm ischemia time, cold ischemia time and anastomosis time were 165 seconds, 66 minutes and 33 minutes respectively. Donor relationships were spousal (n= 40), parental (n=13) or others (n=3), with median HLA match of 1. Graft survival was 100 %. Three patients died with functioning graft due to sepsis and cardiac disease, and 16% had biopsy proven acute rejection. Mean serum creatinine at last follow-up was 1.2 mg/dl. Conclusion KPD is viable, legal and rapidly growing modality for facilitating LDRT for patients who are incompatible with their healthy, willing living donor. To our knowledge, it is largest single-center report from developing country.