Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Nov 6, 2016; 5(6): 531-537
Published online Nov 6, 2016. doi: 10.5527/wjn.v5.i6.531
Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India
Vivek B Kute, Himanshu V Patel, Umesh T Varyani, Pankaj R Shah, Pranjal R Modi, Veena R Shah, Sayyed J Rizvi, Bipin C Pal, Priya S Shah, Pavan S Wakhare, Vijay A Ghodela, Saiprasad G Shinde, Varsha B Trivedi, Minaxi H Patel, Hargovind L Trivedi
Vivek B Kute, Himanshu V Patel, Umesh T Varyani, Pankaj R Shah, Priya S Shah, Pavan S Wakhare, Vijay A Ghodela, Saiprasad G Shinde, Hargovind L Trivedi, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
Pranjal R Modi, Sayyed J Rizvi, Bipin C Pal, Department of Urology and Transplantation, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
Veena R Shah, Department of Anesthesia, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
Varsha B Trivedi, Minaxi H Patel, Department of Pathology and laboratory medicine, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
Author contributions: All authors contributed equally to this clinical team work.
Institutional review board statement: The study was reviewed and approved by the Science and Research Office of IKDRC-ITS, Ahmedabad (India).
Informed consent statement: All study participants or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Vivek B Kute, MBBS, MD, FCPS, DM, Associate Professor, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, B-130, Triveni, Ph-1, Ahmedabad 380016, India. drvivekkute@rediffmail.com
Telephone: +91-90-99927543
Received: May 9, 2016
Peer-review started: May 11, 2016
First decision: June 14, 2016
Revised: August 2, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 6, 2016
Abstract
AIM

To avoid desensitization protocols and ABO incompatible kidney transplantation (KT) due to high costs and increased risk of infections from intense immunosuppression.

METHODS

We present institutional ethical review board - approved study of single center 6-way kidney exchange transplantation. The participants comprised ABO incompatibility (n = 1); positive cross-match and/or presence of donor specific antibody (n = 5). The average time required from registration in kidney paired donation (KPD) registry to find suitable donors was 45 d and time required to perform transplants after legal permission was 2 mo.

RESULTS

Graft and patient survival were 100%, and 100%, respectively. One patient had biopsy-proven acute borderline T cell rejection (Banff update 2013, type 3). Mean serum creatinine was 0.8 mg/dL at 9 mo follow-up. The waiting time in KPD was short as compared to deceased donor KT.

CONCLUSION

We report first non-simultaneous, single center, 6-way kidney exchange transplantation from India. Our experience will encourage other centers in India to undertake this practice.

Keywords: Kidney transplantation/methods, Kidney paired donation, Living donors/supply and distribution, Donor selection/methods

Core tip: We report first non-simultaneous single center 6-way kidney exchange transplantation from India which has the potential to expand the living donor pool and increases kidney transplant opportunity for immunologically sensitized patients. Simultaneous transplant surgery is an accepted standard practice in kidney paired donation and should be encouraged. Non-simultaneous paired exchange transplants should be cautiously performed in carefully selected donors/recipient pairs with “due diligence” and legal permission from institutional ethical review board and written informed consent from the donors/recipients. Counseling to understand the risks and benefits of this procedure is mandatory.