Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation
2005
ContextFirst proposed 2 decades ago, live kidney paired donation (KPD) was
considered a promising new approach to addressing the shortage of organs for
transplantation. Ethical, administrative, and logistical barriers initially
proved formidable and prevented the implementation of KPD programs in the
United States.ObjectiveTo determine the feasibility and effectiveness of KPD for the management
of patients with incompatible donors.Design, Setting, and PatientsProspective series of paired donations matched and transplanted from
a pool of blood type or crossmatch incompatible donors and recipients with
end-stage renal disease (6 conventional and 4 unconventional KPD transplants)
at a US tertiary referral center (between June 2001 and November 2004) with
expertise in performing transplants in patients with high immunologic risk.InterventionKidney paired donation and live donor renal transplantation.Main Outcome MeasuresPatient survival, graft survival, serum creatinine levels, rejection
episodes.ResultsA total of 22 patients received transplants through 10 paired donations
including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up
of 13 months (range, 1-42 months), the patient survival rate was 100% and
the graft survival rate was 95.5%. Twenty-one of the 22 patients have functioning
grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8
mg/dL) (106.1 μmol/L [range, 70.7-159.1 μmol/L]). There were no instances
of antibody-mediated rejection despite the inclusion of 5 patients who were
highly sensitized to HLA antigens due to previous exposure to foreign tissue.
Four patients developed acute cellular rejection (18%).ConclusionsThis series of patients who received transplants from a single-center
KPD pool provides evidence that recipients with incompatible live donors,
even those with rare blood type combinations or high degrees of HLA antigen
sensitization, can receive transplants through KPD with graft survival rates
that appear to be equivalent to directed, compatible live donor transplants.
If these results can be generalized, broader availability of KPD to the estimated
6000 patients with incompatible donors could result in a large expansion of
the donor pool.
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