Global kidney exchange debated in the October issue of American Journal of Transplantation

The October issue of the AJT starts off with a news report, and ends with six letters to the editor (3 of which are replies by us to the letters and to the editorial that was published along with our original article in the March 2017 issue).

The AJT Report

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Global Kidney Exchange: Overcoming the Barrier of Poverty (pages 2499–2500)

Lara C. Pullen

Version of Record online: 28 SEP 2017 | DOI: 10.1111/ajt.14469

This month's installment of “The AJT Report” debates the benefits, ethics and sustainability of Global Kidney Exchange. We also look at efforts to shore kidney paired donation implementation in the United States.

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Letters to the Editor

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Kidney Paired-Donation Program Versus Global Kidney Exchange in India (pages 2740–2741)

V. Kute, R. M. Jindal and N. Prasad

Version of Record online: 22 MAY 2017 | DOI: 10.1111/ajt.14324

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Comment: Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation (page 2742)

L. S. Baines and R. M. Jindal

Version of Record online: 15 MAY 2017 | DOI: 10.1111/ajt.14325

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Global kidney exchange: Financially incompatible pairs are not transplantable compatible pairs (pages 2743–2744)

M. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig and T. B. Dunn

Version of Record online: 1 SEP 2017 | DOI: 10.1111/ajt.14451

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Opposition to irresponsible global kidney exchange (pages 2745–2746)

Francis L. Delmonico and Nancy L. Ascher

Version of Record online: 2 SEP 2017 | DOI: 10.1111/ajt.14473

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People should not be banned from transplantation only because of their country of origin (pages 2747–2748)

Alvin E. Roth, Kimberly D. Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L. Marsh, Alexandra J. Wenig, Ty B. Dunn and Michael A. Rees

Version of Record online: 13 SEP 2017 | DOI: 10.1111/ajt.14485

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Open dialogue between professionals with different opinions builds the best policy (page 2749)

Ignazio R. Marino, Alvin E. Roth, Michael A. Rees and Cataldo Doria

Version of Record online: 11 SEP 2017 | DOI: 10.1111/ajt.14484

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A transplant center in India has done 300 kidney exchange transplants

Here's the article, whose first author is Dr. Vivek Kute, of the Faculty of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

Transpl Int. 2017 Mar 20. doi: 10.1111/tri.12956. [Epub ahead of print]

Impact of Single-Centre Kidney Paired Donation Transplantation to Increase the Donor Pool in India.

Kute VB1, Patel HV1, Shah PR1, Modi PR2, Shah VR3, Rizvi SJ2, Pal BC2, Shah PS1, Modi MP3, Butala BP3, Wakhare PS1, Varyani UT1, Shinde SG1, Ghodela VA1, Kasat GS1, Patil MV1, Patel JC1, Kumar DP1, Trivedi VB4, Patel MH4, Trivedi HL1.

Author information

Abstract

In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n=222), positive cross match (n=59) and better matching (n=19). A total of 124 two-way (n=248), 14 three-way (n=42), one 4-way (n=4) and one 6-way exchange (n=6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n=288) and 83.3% (n=250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3±3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. This article is protected by copyright. All rights reserved.

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Here's a related recent article by Dr. Kute:

World J Transplant. 2017 Feb 24;7(1):64-69. doi: 10.5500/wjt.v7.i1.64.

International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India.

Kute VB1, Patel HV1, Shah PR1, Modi PR1, Shah VR1, Rizvi SJ1, Pal BC1, Shah PS1, Wakhare PS1, Shinde SG1, Ghodela VA1, Varyani UT1, Patel MH1, Trivedi VB1, Trivedi HL1.

Author information

Abstract

AIM:

To report the first international living related two way kidney paired donation (KPD) transplantation from India which occurred on 17th February 2015 after legal permission from authorization committee.

METHODS:

Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-match and donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD.

RESULTS:

Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/dL on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.

CONCLUSION:

International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.

More on starting kidney exchange chains with deceased donor kidneys

Here's a forthcoming letter to the editor in the American Journal of Transplantation: We need to take the next step, by Marc L. Melcher, John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees

It replies to another letter: A potential solution to make best use of living donor- deceased donor list exchange by VB Kute, HV Patel, PR Shah, PR Modi, VR Shah, HL Trivedi

which was prompted by our earlier article: Melcher, Marc L., John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees, “Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains,” American Journal of Transplantation, 16, 5, May 2016, 1367–1370.


Here's a post about that earlier article:

Using deceased donor kidneys to start living donor kidney exchange chains

and here's a post about the followup we hope to do:

White House Organ Summit--video and links. Deceased donor chains planned at Walter Reed

77 Kidney Exchange transplants in 2015 at one transplant center in India

I received the following cheerful news from Dr. Vivek Kute at the Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences ,
(IKDRC-ITS) Ahmedabad , India

 Kidney Paired Donation (KPD) Transplantation Activity At Single Center In Institute Of Kidney Diseases And Research Center And Dr. H L Trivedi Institute Of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

Kute VB , Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR , Varyani UT, Wakhare PS ,  Shinde  SG,  Godhela VA, Shah PS , MK Shah , Gattani VS ,Shah JH, Wadhai KG , Trivedi VB, Patel MH, Trivedi HL.

1) We have performed the largest number of KPD Transplantations (77 patients from 1 Jan 2015 to 1 Jan 2016) in our single center and to the best of our knowledge this is largest number for KPD transplants in single center in one year in the World. KPD constitutes 25% of living donor kidney transplant (LDKT) in 2015.

2) We have performed 274 KPD Transplantations in Our Single Center from Year 2000- 2015 and total 231 KPD Transplantations from Year 2011-2015

3) We Have Performed First Non-Simultaneous Domino Chain Transplant of 6 ESRD Patients and 6 Donors in Single Center in August 2015.

4) We Have Performed First International KPD Transplant on 17 Feb 2015.

5) In The Year 2013, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 15.8% of LDKT in 2013.

6) In The Year 2014, we have performed 56 Kidney Paired Donation Transplantations in our single center. KPD constitutes 18.1% of LDKT in 2014.

7) We Have Performed Ten KPD Transplantations on World Kidney Day 2013 in Single Day in Our Single Center on 14 March 2013.

8) We Have Performed Successful Three-Way KPD Transplantation: First Time in India on 13 February 2013.

9) We Have Performed Successful Three-Way KPD Transplantation in Combination with Desensitization Protocol: First Time in India on 6 May 2014.

Under Mentorship of Prof. HL Trivedi, Vivek Kute is mainly focused on expanding donor pool and kidney-paired donation (KPD) transplantation. 

Correspondence Address

Dr.Vivek Kute. 

MBBS, MD, FCPS, DM Nephrology (Gold Medalist), FASN

Associate Professor , Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences , (IKDRC-ITS) Ahmedabad , India

(M) : +919099927543  

Email: drvivekkute@rediffmail.com  

Website : www.ikdrc-its.org

Ten kidney exchange transplants on World Kidney Day in Ahmedabad, India

Here's the link:

Clinical Studies

Ten kidney paired donation transplantation on World Kidney Day 2013: raising awareness and time to take action to increase donor pool

Posted online on August 12, 2013. (doi:10.3109/0886022X.2013.823997)

Vivek B. Kute¹, Aruna V. Vanikar², Pankaj R. Shah¹, Manoj R. Gumber¹, Himanshu V. Patel¹, Divyesh P. Engineer¹, Pranjal R. Modi³, S.J. Rizvi³, Veena R. Shah⁴, Manisha P. Modi⁴, Kamal V. Kanodia², and Hargovind L. Trivedi¹

¹Department of Nephrology and Clinical Transplantation,

²Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology,

³Department of Urology and Transplantation, and

⁴Anesthesia and Critical Care, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS),

Ahmedabad

, India

Address correspondence to

Dr. Vivek Kute

, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases & Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC- ITS), Civil Hospital Campus,

Ahmedabad 380016, Gujarat

, India. Tel.: +91 79 22687000; Fax: +91 79 2268 5454; E-mail: drvivekkute@rediffmail.com

Abstract

Background: Kidney paired donation (KPD) is feasible for any center that performs living related donor renal transplantation (LRDRTx). Lack of awareness, counseling and participation are important hurdles in KPD patients with incompatible donors. Materials and methods: This is an institutional review board approved study of 10 ESRD patients who consented to participate in the KPD transplantation at our center. All the surgeries were carried out on the same day at the same center on the occasion of World Kidney Day (WKD) (14 March 2013). All recipients had anatomic, functional and immunological similar donors. Results: KPD were performed to avoid blood group incompatibility (n = 8) or to avoid a positive crossmatch (n = 2). None of the patients experienced delayed graft function and surgical complications. At 3 month follow-up, median serum creatinine was 1 (range 0.6 to 1.25) mg/dL and two patients developed allograft biopsy-proven acute rejection and responded to antirejection therapy. Due to impact of our awareness activity, 20 more KPD patients are medically fit for transplantation and waiting for permission from the authorization committee before transplantation. Conclusion: This is a report of 10 simultaneous KPD transplantations in a single day in a single centre on WKD raising awareness of KPD. KPD is viable, legal and rapidly growing modality for facilitating LRDRTx for patients who are incompatible with their healthy, willing LRD.

Read More: http://informahealthcare.com/doi/abs/10.3109/0886022X.2013.823997

Kidney exchange in India

Outcome of kidney paired donation transplantation to increase donor pool and to prevent commercial transplantation: a single-center experience from a developing country.

Kute VB, Gumber MR, Patel HV, Shah PR, Vanikar AV, Modi PR, Shah VR, Patel MP, Trivedi HL.

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.