Outcome of kidney paired donation transplantation to increase donor pool and to prevent commercial transplantation: a single-center experience from a developing country.
Source
Department of Nephrology and Clinical Transplantation, Institute of Kidney
Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation
Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat,
India, drvivekkute@rediffmail.com.
Abstract
BACKGROUND:
Economic constraints in operating an effective maintenance dialysis program
leaves renal transplantation as the only viable option for end-stage renal
disease patients in India. Kidney paired donation (KPD) is a rapidly growing
modality for facilitating living donor (LD) transplantation for patients who are
incompatible with their healthy, willing LD.
MATERIALS AND METHODS:
The aim of our study was to report a single-center feasibilities and outcomes
of KPD transplantation between 2000 and 2012. We performed KPD transplants in 70
recipients to avoid blood group incompatibility (n = 56) or to avoid a positive
crossmatch (n = 14).
RESULTS:
Over a mean follow-up of 2.72 ± 2.96 years, one-, five- and ten-year patient
survival were 94.6, 81, 81 %, and death-censored graft survival was 96.4, 90.2,
90.2 %, respectively. Ten percent of patients were lost, mainly due to
infections (n = 4). There was 14.2 % biopsy-proven acute rejection, and 5.7 %
interstitial fibrosis with tubular atrophy eventually leading to graft loss.
CONCLUSION:
The incidences of acute rejection, patient/graft survival rates were
acceptable in our KPD program and, therefore, we believe it should be
encouraged. These findings are valuable for encouraging participation of KPD
pairs and transplant centers in national KPD program. It should be promoted in
centers with low-deceased donor transplantation. Our study findings are relevant
in the context of Indian government amending the Transplantation of Human Organs
Act to encourage national KPD program. To our knowledge, it is largest
single-center report from India.
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