Paired exchange kidney donation in India: a five-year single-center experience

Abstract

Paired exchange kidney donation (PKD) is an evolving strategy for overcoming the barriers that confront patients with end-stage renal disease, when the only living potential donors who are willing to donate to them are deemed to be unsuitable as donors for them owing to an incompatibility of blood type, of HLA cross-match, or of both. In the PKD, the incompatibility problems with two donor recipient pairs can be solved by exchanging donors. Although PKD is increasing worldwide, we in India have not nearly reached the estimated potential of this modality. Herein, we have reported our results with a living donor exchange program in past 5 years. Between March 2006 and June 2011, we performed 44 living PKD transplantations. All donor and recipient procedures were performed successfully. ABO incompatibility or positive lymphocyte cross-match were found in 20 pairs and 2 pairs, respectively. The mean recipient age was 42.5 years (range 33–59 years). The mean donor age was 38 years (range 31–56 years). At a median follow-up of 33 months (range 1–59 months), graft survival rate was 100 %. All patients have functioning grafts with a median serum Creatinine level of 1.13, 1.5, and 1.35 mg/dl at 3 month, 1 year, and 3 years, respectively. One patient died after 4 month of transplant due to pneumonitis with sepsis. Allograft dysfunction was not seen in any of the recipients. The PKD transplantation is a viable procedure medically and economically, which can be promoted in centers with a low deceased donor transplantation rate and a high number of incompatible related donors. We achieved excellent graft outcome by using the PKD transplantation program as an option to reduce the donor organ shortage.