KPD: a model for the developing world to prevent commercial transplantation

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/tri.12373/abstract?campaign=wolacceptedarticle

Increasing access to renal transplantation in India through our single-center kidney paired donation program: a model for the developing world to prevent commercial transplantation
Vivek B. Kute1,*, Priyadarshini S. Shah2, Aruna V. Vanikar2, Manoj R. Gumber1, Himanshu V. Patel1, Divyesh P. Engineer1, Pankaj R. Shah1, Pranjal R. Modi3, Veena R Shah4, S.J. Rizvi4 andHargovind L. Trivedi1
DOI: 10.1111/tri.12373
Transplant International

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) patient in India

Materials and methods
We present a government and institutional ethical review board approved study of 56 ESRD patients [25 two-way and 2 three-way pairs] who consented to participate in KPD transplantation at our center in 2013, performed to avoid blood group incompatibility(n=52) or positive cross-match (n=4). All patients had anatomic, functional and immunologically comparable donors.

Results
The waiting time in KPD was short as compared to deceased donor transplantation. Laparoscopic donor nephrectomy was performed in 54 donors. Donor relationships were spousal(n= 40), parental(n=13), others(n=3), with median HLA match of 1. Graft survival was 97.5%. Three patients died with functioning graft. 16% had biopsy proven acute rejection. Mean serum creatinine was 1.2 mg/dl at 0.73 ± 0.32 months follow-up

Conclusion
KPD is a viable, legal and rapidly growing modality for facilitating LDRT for patients who are incompatible with their healthy, willing living donor. To our knowledge, this is the largest single-center report from India.