Abstract
Barriers to traditional living-donor kidney transplantation include ABO incompatibility and positive cross-match. Paired exchange kidney transplantation (PEKT) is a viable an increasingly popular method to increase live donation. We discuss the pros and cons as well as the various ways to achieve PEKT along with a review of existing literature. To achieve the full potential of PEKT, the transplant community at large needs to work toward a national kidney paired donation program along with a centralized financial intermediary.
Highlights
Kidney transplantation is the treatment of choice for patients with end stage renal disease
Paired-exchange kidney transplantation (PEKT) is an innovative approach that can overcome these hurdles which is becoming popular in the United States
The idea of PEKT was first proposed by Felix Rapaport in 1986 though first PEKT was performed in the United States in 2000 [4]
Summary
Kidney transplantation is the treatment of choice for patients with end stage renal disease. Desensitization therapies have been used to enable successful transplantation across incompatible donor-recipient pairs, but these procedures are associated with higher costs, complications and inferior long-term outcomes [2]. Paired-exchange kidney transplantation (PEKT) is an innovative approach that can overcome these hurdles which is becoming popular in the United States. Computer simulation modeling has shown that PEKT can lower costs with improved outcomes compared to desensitization [3]. Many transplant centers started participating in PEKT. In the United States, paired kidney donation increased from around 200 in year 2008 to greater than 400 in 2011 [6]. While Canada has established a single national kidney paired donation registry, Unites States currently has seven active multicenter registries in addition to single center registries. A consensus conference was convened in March 2012 that addressed challenges of PEKT and strongly emphasized the need for developing a single well-functioning national registry for PEKT [7]
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