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Kute VB, Patel HV, Banerjee S, Aziz F, Godara SM, Bansal SB, Bhalla AK, Modi P, Sharma A, Billa V, Narayanan S, Ranjan P, Singla M, Soin AS, Gupta S, Guleria S, Bhangui P, Gupta A, Ray DS, Engineer DP, Rizvi J, Parmar V, Bahadur MM, Singh S, Shingare AP, Shah BV, Hafeeq B, Aboobacker IN, Barnela S, Chauhan M, Varughese S, Khullar D, Rela M, Kothari J, Bichu S, Kumar D, Das P, Gopinathan JC, Eapen JJ, Das SS, Prakash S, Kumar BT A, Ambike S, Angral R, Saxena S, Bavikar S, Tripathi V, Srinivasa S, Hegde U, Siddini V, Mohanty N, Mammen KJ, Abraham M A, Bajpai D, Chauhan S, Kumar A, Balwani MR, Meshram HS, Mohanka R, Sudhindran S, Chaubal G, Srinivasan T, Rammohan A, Mishra V, Thukral S, Bavikar P, Jamale T, Kriplani J, Girish N, Parikh K, Jeloka T, Sreekumar V, Aslam S, Guptha V, Agarwal D, Gulati S, Gupta A, Kiran MK, Anandh U, Gumber M, Chowdhary PK, Khetan P, Nayak K, Deshpande R, Godhani U, Pattewar S, Mehta K, Inamdar N, Yadav RK, Shrimali J, Goswami J, Garsa R, Balasubramaniyam R, Mukkavilli KK, Sharma RK, Soni S, Wani I, Kakde S, Prasad N, Singh G, et alKute VB, Patel HV, Banerjee S, Aziz F, Godara SM, Bansal SB, Bhalla AK, Modi P, Sharma A, Billa V, Narayanan S, Ranjan P, Singla M, Soin AS, Gupta S, Guleria S, Bhangui P, Gupta A, Ray DS, Engineer DP, Rizvi J, Parmar V, Bahadur MM, Singh S, Shingare AP, Shah BV, Hafeeq B, Aboobacker IN, Barnela S, Chauhan M, Varughese S, Khullar D, Rela M, Kothari J, Bichu S, Kumar D, Das P, Gopinathan JC, Eapen JJ, Das SS, Prakash S, Kumar BT A, Ambike S, Angral R, Saxena S, Bavikar S, Tripathi V, Srinivasa S, Hegde U, Siddini V, Mohanty N, Mammen KJ, Abraham M A, Bajpai D, Chauhan S, Kumar A, Balwani MR, Meshram HS, Mohanka R, Sudhindran S, Chaubal G, Srinivasan T, Rammohan A, Mishra V, Thukral S, Bavikar P, Jamale T, Kriplani J, Girish N, Parikh K, Jeloka T, Sreekumar V, Aslam S, Guptha V, Agarwal D, Gulati S, Gupta A, Kiran MK, Anandh U, Gumber M, Chowdhary PK, Khetan P, Nayak K, Deshpande R, Godhani U, Pattewar S, Mehta K, Inamdar N, Yadav RK, Shrimali J, Goswami J, Garsa R, Balasubramaniyam R, Mukkavilli KK, Sharma RK, Soni S, Wani I, Kakde S, Prasad N, Singh G, Soni R, Shankar A, Gireesh M, Srivastava A. Analysis of kidney and liver exchange transplantation in India (2000–2025): a multicentre, retrospective cohort study. THE LANCET REGIONAL HEALTH - SOUTHEAST ASIA 2025; 37:100597. [DOI: 10.1016/j.lansea.2025.100597] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2025]
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Kute VB, Patel HV, Banerjee S, Engineer DP, Dave RB, Shah N, Chauhan S, Meshram H, Tambi P, Shah A, Saxena K, Balwani M, Parmar V, Shah S, Prakash V, Patel S, Patel D, Desai S, Rizvi J, Patel H, Parikh B, Kanodia K, Gandhi S, Rees MA, Roth AE, Modi P. Impact of single centre kidney-exchange transplantation to increase living donor pool in India: A cohort study involving non-anonymous allocation. Nephrology (Carlton) 2024; 29:917-929. [PMID: 39245449 DOI: 10.1111/nep.14380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024]
Abstract
AIM In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%-35%. METHODS We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT. RESULTS Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2-way (n = 2 × 202 = 404), 16.2% 3-way (n = 3 × 29 = 87), 3% 4-way (n = 4 × 4 = 16), 1.8% 5-way (n = 5 × 2 = 10), 2.2% 6-way (n = 6 × 2 = 12), and 1.8% 10-way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow-up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high-volume LDKT programs, non-anonymous allocation and teamwork. CONCLUSION This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Divyesh P Engineer
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Ruchir B Dave
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Nauka Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sanshriti Chauhan
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Harishankar Meshram
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Priyash Tambi
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Akash Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Khushboo Saxena
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Manish Balwani
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vishal Parmar
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Shivam Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Ved Prakash
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sudeep Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Dev Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sudeep Desai
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Jamal Rizvi
- Department of Urology and Transplantation, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Harsh Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Beena Parikh
- Department of Anaesthesiology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Kamal Kanodia
- Department of Pathology, laboratory medicine, transfusion services and immunohematology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Shruti Gandhi
- Department of Radiology, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
| | - Michael A Rees
- Alliance for Paired Kidney Donation, Perrysburg, Ohio, USA
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, California, USA
| | - Pranjal Modi
- Department of Urology and Transplantation, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Gujarat University of Transplantation Sciences (GUTS), Ahmedabad, India
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Serban AM, Ionescu NS. Surgical patient registries: scoping study of challenges and solutions. J Public Health Policy 2023; 44:523-534. [PMID: 37726394 DOI: 10.1057/s41271-023-00442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/21/2023]
Abstract
Patient surgical registries are essential tools for public health specialists, creating research opportunities through linkage of registry data with healthcare outcomes. However, little is known regarding data error sources in the management of surgical registries. In June 2022, we undertook a scoping study of the empirical literature including publications selected from the PUBMED and EMBASE databases. We selected 48 studies focussing on shared experiences centred around developing surgical patient registries. We identified seven types of data specific challenges, grouped in three categories- data capture, data analysis and result dissemination. Most studies underlined the risk for a high volume of missing data, non-uniform geographic representation, inclusion biases, inappropriate coding, as well as variations in analysis reporting and limitations related to the statistical analysis. Finally, to expand data usability, we discussed cost-effective ways of addressing these limitations, by citing aspects from the protocols followed by established exemplary registries.
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Affiliation(s)
- Andreea Madalina Serban
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474, Bucharest, Romania.
- Maria Sklodowska Curie Emergency Hospital for Children, 20 Brancoveanu Blvd., 077120, Bucharest, Romania.
| | - Nicolae Sebastian Ionescu
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474, Bucharest, Romania
- Maria Sklodowska Curie Emergency Hospital for Children, 20 Brancoveanu Blvd., 077120, Bucharest, Romania
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Kute VB, Fleetwood VA, Chauhan S, Meshram HS, Caliskan Y, Varma C, Yazıcı H, Oto ÖA, Lentine KL. Kidney paired donation in developing countries: A global perspective. CURRENT TRANSPLANTATION REPORTS 2023; 10:117-125. [PMID: 37720696 PMCID: PMC10501157 DOI: 10.1007/s40472-023-00401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW We review the key principles of kidney paired donation (KPD) and discuss the status and unique considerations for KPD in developing countries. RECENT FINDINGS Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices. SUMMARY KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need world-wide.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Vidya A. Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Chintalapati Varma
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Halil Yazıcı
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Özgür Akın Oto
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Altun E, Yavuz M. Long-Term Outcomes of Kidney Paired Donation Transplantation: A Single Center Retrospective Cohort Study. Transplant Proc 2023; 55:325-331. [PMID: 36890053 DOI: 10.1016/j.transproceed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND This study aimed to compare the kidney paired donation (KPD) program recipients with the traditional living donor kidney transplantation (LDKT) recipients regarding patient and graft survival. METHODS We retrospectively analyzed 141 recipients of the KPD program and 141 classic LDKT recipients that we matched for age and sex as controls between July 2005 and June 2019. We compared the 2 transplant groups for patient and kidney survival using the Kaplan-Maier test. We also performed Cox Regression analysis to examine factors affecting patient survival, including transplant type. RESULTS The average follow-up period was 96.17 ± 44.22 months. Of the 282 patients, 88 died in the follow-up period. There was no statistically significant difference in graft and patient survival between the KPD and LDKT groups. In the Cox regression model, including the transplant type, only the serum creatinine level measured in the first month after discharge was a significant factor in predicting patient survival. CONCLUSIONS The findings of this study indicate that the KPD program is an effective and reliable method to increase LDKT. Country-wide multicentric studies should confirm the results of this study. In countries where cadaver transplantation is insufficient, efforts should be made to expand the KPD program.
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Affiliation(s)
- Eda Altun
- Bahcesehir University Faculty of Medicine, Department of Nephrology, Goztepe Medicalpark Hospital, Istanbul, Turkey.
| | - Melike Yavuz
- Bahcesehir University Faculty of Medicine, Department of Public Health, Istanbul
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Kute VB, Chauhan S, Navadiya VV, Meshram HS, Patel HV, Engineer D, Banerjee S, Desai S, Shah N, Rizvi J, Mishra VV. India: Gender Disparities in Organ Donation and Transplantation. Transplantation 2022; 106:1293-1297. [PMID: 35731149 DOI: 10.1097/tp.0000000000003960] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Vijay V Navadiya
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Hari Shankar Meshram
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Himanshu V Patel
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Divyesh Engineer
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Subho Banerjee
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sudep Desai
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Nauka Shah
- Department of Nephrology and Transplantation Sciences, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Jamal Rizvi
- Department of Transplantation Surgery, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Vineet V Mishra
- Department of Gynecology and Director, IKDRC-ITS, Ahmedabad, India
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Bastos J, Machado DJDB, David-Neto E. Increasing transplantability in Brazil: time to discuss Kidney Paired Donation. J Bras Nefrol 2021; 44:417-422. [PMID: 35107119 PMCID: PMC9518625 DOI: 10.1590/2175-8239-jbn-2021-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction: Kidney transplantation (KT) is the best treatment for chronic kidney disease. In Brazil, there are currently more than 26 thousand patients on the waitlist. Kidney Paired Donation (KPD) offers an incompatible donor-recipient pair the possibility to exchange with another pair in the same situation, it is a strategy to raise the number of KT. Discussion: KPD ceased being merely an idea over 20 years ago. It currently accounts for 16.2% of living donors KT (LDKT) in the USA and 8% in Europe. The results are similar to other LDKT. It is a promising alternative especially for highly sensitized recipients, who tend to accumulate on the waitlist. KPD is not limited to developed countries, as excellent results were already published in India in 2014. In Guatemala, the first LDKT through KPD was performed in 2011. However, the practice remains limited to isolated cases in Latin America. Conclusion: KPD programs with different dimensions, acceptance rules and allocation criteria are being developed and expanded worldwide to meet the demands of patients. The rise in transplantability brought about by KPD mostly meets the needs of highly sensitized patients. The Brazilian transplant program is mature enough to accept the challenge of starting its KPD program, intended primarily to benefit patients who have a low probability of receiving a transplant from a deceased donor.
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Affiliation(s)
- Juliana Bastos
- Santa Casa de Misericórdia de Juiz de Fora, Departamento de Transplante, Juiz de Fora, MG, Brasil
| | | | - Elias David-Neto
- Hospital das Clínicas da Universidade de São Paulo, Departamento de Transplante, São Paulo, SP, Brasil
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Bansal SB, Gade A, Sinha S, Mahapatra A, Jha P, Sethi SK. HLA Desensitization Based on Results of the Luminex Technique in Kidney Transplant - A Single-center Experience. Indian J Nephrol 2021; 31:454-459. [PMID: 34880555 PMCID: PMC8597796 DOI: 10.4103/ijn.ijn_237_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/19/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background: There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results. Method: Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative. Results: All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up. Conclusion: This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.
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Affiliation(s)
- S B Bansal
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - A Gade
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - S Sinha
- Department of Nephrology, BYL Nair Hospital, Mumbai, Maharashtra, India
| | - A Mahapatra
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - P Jha
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
| | - S K Sethi
- Department of Nephrology, Medanta Kidney and Urology Institute, Medanta-Medicity, Gurugram, Haryana, India
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Jha PK, Yadav DK, Siddini V, Bansal SB, Sharma R, Anandh U, Jeloka T, Reddy S, Pokhariyal S, Nandwani A, Jain S, Saxena V, Sethi SK, Bansal D, Jain M, Sodhi P, Gadde A, Augustine R, Zafar FA, Ghosh P, Tiwari AK, Ahlawat R, Kher V. A retrospective multi-center experience of renal transplants from India during COVID-19 pandemic. Clin Transplant 2021; 35:e14423. [PMID: 34255903 PMCID: PMC8420412 DOI: 10.1111/ctr.14423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/21/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) pandemic led to a sudden drop in renal transplant numbers across India in the initial months of 2020. Although the transplant numbers increased with easing of lockdown, the outcome of these transplants remains unknown. METHODS This was a retrospective, observational, multi-center study done across eight different transplant centers in India. All the transplants done from January 30, 2020 to December 31, 2020 were included. The primary outcomes studied were patient and death censored graft survival as well as incidence of COVID-19 infection and its outcomes. RESULTS During the study period a total of 297 kidney transplants were done. After a median follow up of 265 days the patient and death censored graft survival was 95.3% and 97.6%, respectively. Forty-one patients (13.8%) developed COVID-19 post-transplant. Majority (58.5%) were asymptomatic to mildly symptomatic and the case fatality ratio was 14.6%. On multivariable logistic regression analysis older age was associated with higher likelihood of COVID-19 infection (odds ratio 1.038; CI 1.002-1.077). CONCLUSIONS Patient and graft outcome of kidney transplants done during the COVID-19 pandemic in India was acceptable. The incidence of COVID-19 was 13.8% with a high case fatality ratio.
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Affiliation(s)
- Pranaw Kumar Jha
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Dinesh Kumar Yadav
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Vishwanath Siddini
- Department of NephrologyManipal HospitalsOld Airport RoadBengaluruKarnatakaIndia
| | - Shyam Bihari Bansal
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Reetesh Sharma
- Nephrology and Kidney Transplant MedicineAsian Institute of Medical SciencesFaridabadHaryanaIndia
| | - Urmila Anandh
- Department of NephrologyYashoda HospitalsSecunderabadTelanganaIndia
| | - Tarun Jeloka
- Department of Nephrology and Renal TransplantAditya Birla Memorial HospitalPuneMaharashtraIndia
| | - Sreedhar Reddy
- Department of NephrologyKrishna Institute of Medical SciencesSecunderabadTelanganaIndia
| | | | | | - Salil Jain
- Department of NephrologyFortis Memorial Research InstituteGurugramHaryanaIndia
| | - Vishal Saxena
- Department of NephrologyFortis Memorial Research InstituteGurugramHaryanaIndia
| | - Sidharth Kumar Sethi
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Dinesh Bansal
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Manish Jain
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Puneet Sodhi
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Ashwini Gadde
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Rohan Augustine
- Department of NephrologyManipal HospitalsOld Airport RoadBengaluruKarnatakaIndia
| | - Feroz Amir Zafar
- Department of UrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Prasun Ghosh
- Department of UrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Aseem Kumar Tiwari
- Department of Transfusion MedicineMedanta – The MedicityGurugramHaryanaIndia
| | - Rajesh Ahlawat
- Department of UrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
| | - Vijay Kher
- Department of NephrologyMedanta Institute of Kidney and UrologyMedanta – The MedicityGurugramHaryanaIndia
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10
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Kute VB, Meshram HS. Will the Living Donor Liver and Kidney Exchange Program Succeed? INDIAN JOURNAL OF TRANSPLANTATION 2021; 15:388-389. [DOI: 10.4103/ijot.ijot_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Kute VB, Meshram HS, Patel HV, Engineer D, Banerjee S, Chauhan S, Navadiya VV, Patel H, Gupta A, Rizvi J, Mishra VV. First Single-Center Five-Way Kidney Exchange Cycle in India. INDIAN JOURNAL OF TRANSPLANTATION 2021; 15:338-342. [DOI: 10.4103/ijot.ijot_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective:
The logistical issues, limited resources, and surgical capacity are the challenges to simultaneous kidney exchange transplant surgeries in India. We report the first single-center 5-way nonsimultaneous kidney exchange cycle from India without donor renege. The challenges and solutions for the same are discussed.
Methods:
Five donor–recipient pairs (DRPs) participated in 5-way kidney exchange cycle after permission of Institutional and Gujarat State Level Authorization Committee for organ transplantation. Four DRP were ABO-incompatible and the fifth was compatible.
Results:
Two DRP were operated on November 22 and three on November 23, 2018. One bridge donor wait time was 1 day. All five recipients were discharged on November 30, 2018, without any medical or surgical complication; normal kidney allograft function and donor renege. We have increased chain length gradually from 2-way (June 2000), 3-way (February 2013), 4-way (April 2016), 5-way (November 2018), 6-way (February 2019), and 10-way (January 2020) in 440 kidney exchange transplants at our institute. We have used compatible pairs in gradually increasing chain length from 2-way (May 2012), 3-way (August 2013), 4-way (July 2018), 5-way (November 2018), and 6-way (February 2019) to increase transplant for difficult to match pairs.
Conclusions:
To the best of our knowledge, this is the first single-center 5-way kidney exchange cycle from India. Increasing chain length has the potential to offer better quality of matching and transplants rates for difficult-to-match pairs in kidney exchange.
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12
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Shroff S, Gill JS. Bold policy changes are needed to meet the need for organ transplantation in India. Am J Transplant 2021; 21:2933-2936. [PMID: 33583127 DOI: 10.1111/ajt.16537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023]
Abstract
Twenty-five years after India passed legislation to legalize brain death, deceased donor transplantation remains underdeveloped while the country has established formidable capacity for living donor transplantation. Because of a large number of potential deceased donors, there is hope that deceased donation could help meet India's enormous need for organ transplantation. However, significant policy and practical barriers limit progress. The vast majority of potential deceased donors are poor motor vehicle accident victims who present for care in hospitals without the necessary infrastructure or expertise to support deceased donation. In contrast, transplant infrastructure and expertise are concentrated in private hospitals and are only accessible to those with the ability to pay. Given these realities, the potential of deceased donor transplantation can only be recognized if Indians who are likely to donate organs are also provided access to transplantation. In this viewpoint, we review the current status of organ transplantation in India and propose new policies to establish a national organization to oversee deceased donor services in all states, to fund resources needed to support deceased donation, to leverage the existing living donor infrastructure to advance deceased donor transplantation, and call for establishment of government policy on funding for posttransplant care and immunosuppression.
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Affiliation(s)
- Sunil Shroff
- Urology and Transplantation, Madras Medical Mission Hospital, Chennai, India
| | - John S Gill
- University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
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13
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Kute VB, Ramesh V, Rela M. On the Way to Self-sufficiency: Improving Deceased Organ Donation in India. Transplantation 2021; 105:1625-1630. [PMID: 34291760 DOI: 10.1097/tp.0000000000003677] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vasanthi Ramesh
- National Organ and Tissue Transplant Organization, New Delhi, India
- The Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mohamed Rela
- Department of Liver Transplantation and Hepatopancreatobiliary Surgery, Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
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14
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Kute VB, Patel HV, Modi PR, Rizvi SJ, Engineer DP, Banerjee S, Butala BP, Gandhi S, Patel AH, Mishra VV. Paired Kidney Exchange in India: Future Potential and Challenges Based on the Experience at a Single Center. Transplantation 2021; 105:929-932. [PMID: 33901126 DOI: 10.1097/tp.0000000000003421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pranjal R Modi
- Department of Transplantation Surgery, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Syed J Rizvi
- Department of Transplantation Surgery, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Divyesh P Engineer
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Bina P Butala
- Department of Anaesthesia, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Shruti Gandhi
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Ansy H Patel
- Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vineet V Mishra
- Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
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15
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Kute VB, Patel HV, Modi PR, Rizvi SJ, Shah PR, Engineer DP, Banerjee S, Meshram HS, Butala BP, Modi MP, Gandhi S, Patel AH, Mishra VV, Roth AE, Kopke JE, Rees MA. Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation - a prospective single-center cohort study. Transpl Int 2021; 34:669-680. [PMID: 33527555 DOI: 10.1111/tri.13833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n = 67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging. We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using 23 bridge-donors without donor renege and no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V Patel
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Pranjal R Modi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Syed J Rizvi
- Department of Urology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Divyesh P Engineer
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Bina P Butala
- Department of Anesthesia, IKDRC-ITS, Ahmedabad, India
| | | | - Shruti Gandhi
- Department of Radiology, IKDRC-ITS, Ahmedabad, India
| | | | | | | | | | - Michael A Rees
- Alliance for Paired Kidney Donation, Perrysburg, OH, USA
- University of Toledo Medical Center, Toledo, OH, USA
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16
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Kute VB, Patel HV, Mishra VV, Agarwal SK. Optimum Chain Length in Kidney Exchange Program and the Way Ahead. Indian J Nephrol 2021; 31:95-96. [PMID: 34267429 PMCID: PMC8240927 DOI: 10.4103/ijn.ijn_376_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/17/2020] [Accepted: 03/08/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V. Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vineet V. Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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17
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Chandar J, Chen L, Defreitas M, Ciancio G, Burke G. Donor considerations in pediatric kidney transplantation. Pediatr Nephrol 2021; 36:245-257. [PMID: 31932959 DOI: 10.1007/s00467-019-04362-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 01/10/2023]
Abstract
This article reviews kidney transplant donor options for children with end-stage kidney disease (ESKD). Global access to kidney transplantation is variable. Well-established national policies, organizations for organ procurement and allocation, and donor management policies may account for higher deceased donor (DD transplants) in some countries. Living donor kidney transplantation (LD) predominates in countries where organ donation has limited national priority. In addition, social, cultural, religious and medical factors play a major role in both LD and DD kidney transplant donation. Most children with ESKD receive adult-sized kidneys. The transplanted kidney has a finite survival and the expectation is that children who require renal replacement therapy from early childhood will probably have 2 or 3 kidney transplants in their lifetime. LD transplant provides better long-term graft survival and is a better option for children. When a living related donor is incompatible with the intended recipient, paired kidney exchange with a compatible unrelated donor may be considered. When the choice is a DD kidney, the decision-making process in accepting a donor offer requires careful consideration of donor history, kidney donor profile index, HLA matching, cold ischemia time, and recipient's time on the waiting list. Accepting or declining a DD offer in a timely manner can be challenging when there are undesirable facts in the donor's history which need to be balanced against prolonging dialysis in a child. An ongoing global challenge is the significant gap between organ supply and demand, which has increased the need to improve organ preservation techniques and awareness for organ donation.
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Affiliation(s)
- Jayanthi Chandar
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami Transplant Institute, PO Box 016960 (M714), Miami, FL, 33101, USA.
| | - Linda Chen
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
| | - Marissa Defreitas
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami Transplant Institute, PO Box 016960 (M714), Miami, FL, 33101, USA
| | - Gaetano Ciancio
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
| | - George Burke
- Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA
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18
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Kher V, Jha PK. Paired kidney exchange transplantation - pushing the boundaries. Transpl Int 2020; 33:975-984. [PMID: 32634850 DOI: 10.1111/tri.13693] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/02/2019] [Accepted: 07/01/2020] [Indexed: 12/28/2022]
Abstract
The scarcity of living organ donors makes it imperative to develop newer innovations to optimize and maximize the utilization of the available pool. ABO and HLA sensitization are important immunological barriers in renal transplant and can potentially lead to rejection of almost one-third of the willing living donors. Paired kidney exchange (PKE) is a rapidly growing method used to overcome these barriers and has grown in popularity over the last three decades since its introduction in 1986. Evolution of the matching strategies and use of complex algorithms has led to increase in the number of possible matches thereby benefiting multiple recipients. The use of altruistic donors and compatible pairs has also helped in increasing the possible exchanges. This review provides an in-depth analysis of the evolution, the present global scenario, and the future of PKE. It also discusses the recent trends of advanced donation, trans-organ paired exchange and global kidney exchange and the associated ethical concerns.
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Affiliation(s)
- Vijay Kher
- Department of Nephrology & Transplant Medicine, Medanta - The Medicity, Gurgaon, Harayana, India
| | - Pranaw Kumar Jha
- Department of Nephrology & Transplant Medicine, Medanta - The Medicity, Gurgaon, Harayana, India
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19
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Ismail MS, Cusick M, Galvan NTN. The Benefits of a Local Kidney Exchange. Tex Heart Inst J 2019; 46:71-72. [PMID: 30833849 DOI: 10.14503/thij-18-6747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Yacoubian AA, Dargham RA, Khauli RB. A review of the possibility of adopting financially driven live donor kidney transplantation. Int Braz J Urol 2019; 44:1071-1080. [PMID: 30044592 PMCID: PMC6442174 DOI: 10.1590/s1677-5538.ibju.2017.0693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/23/2018] [Indexed: 12/28/2022] Open
Abstract
Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.
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Affiliation(s)
- Aline Adour Yacoubian
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Abu Dargham
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raja B Khauli
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
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21
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Flechner SM, Thomas AG, Ronin M, Veale JL, Leeser DB, Kapur S, Peipert JD, Segev D, Henderson ML, Shaffer AA, Cooper M, Hil G, Waterman AD. The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries. Am J Transplant 2018; 18:2730-2738. [PMID: 29603640 PMCID: PMC6165704 DOI: 10.1111/ajt.14744] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 01/25/2023]
Abstract
The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR. Compared with all United Network for Organ Sharing (UNOS) live donor transplant patients (49 610), all UNOS living unrelated transplant patients (23 319), and all other KPD transplant patients (4236), the demographic and clinical characteristics of NKR transplant patients (2037) appear similar to contemporary national trends. In particular, among the NKR patients, there were a significantly (P < .001) greater number of retransplants (25.6% vs 11.5%), hyperimmunized recipients (22.7% vs 4.3% were cPRA >80%), female recipients (45.9% vs 37.6%), black recipients (18.2% vs 13%), and those on public insurance (49.7% vs 41.8%) compared with controls. These results support the need for greater sharing and larger pool sizes, perhaps enhanced by the entry of compatible pairs and even chains initiated by deceased donors, to unlock more opportunities for those harder-to-match pairs.
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Affiliation(s)
| | | | | | | | | | | | - John D Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | | | | | | | | | - Garet Hil
- National Kidney Registry, Babylon, NY
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22
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Kute VB, Prasad N, Shah PR, Modi PR. Kidney exchange transplantation current status, an update and future perspectives. World J Transplant 2018; 8:52-60. [PMID: 29988896 PMCID: PMC6033740 DOI: 10.5500/wjt.v8.i3.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 02/05/2023] Open
Abstract
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n-way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange. Here we discuss recent advances in kidney exchanges such as International kidney exchange transplantation in a global environment, three categories of advanced donation program, deceased donors as a source of chain initiating kidneys, donor renege myth or reality, pros and cons of anonymity in developed world and (non-) anonymity in developing world, pros and cons of donor travel vs kidney transport, algorithm for management of incompatible donor-recipient pairs and pros and cons of Global kidney exchange. The participating transplant teams and donor-recipient pairs should make the decision by consensus about kidney donor travel vs kidney transport and anonymity vs non-anonymity in allocation as per local resources and logistics. Future of organ transplantation in resource-limited setting will be liver vs kidney exchange, a legitimate hope or utopia?
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Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Narayan Prasad
- Department of Nephrology and Clinical Transplantation, SGPGI, Lucknow 226014, India
| | - Pankaj R Shah
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
| | - Pranjal R Modi
- Department of Urology and transplantation, Institute of Kidney Diseases and Research Centre, Dr Trivedi Institute of Transplantation Sciences, Ahmedabad 380016, India
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23
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Baines LS, Dulku H, Jindal RM, Papalois V. Risk Taking and Decision Making in Kidney Paired Donation: A Qualitative Study by Semistructured Interviews. Transplant Proc 2018; 50:1227-1235. [PMID: 29880340 DOI: 10.1016/j.transproceed.2018.02.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite excellent outcomes of kidney paired donation (KPD), little is known about how a patient's frame (apply cognitive bias) or weight (attribute value) and concerns relating to risk, justice, and equity affect his or her decision-making process. MATERIALS AND METHODS A pilot study consisting of 3 KPD transplant recipients and 3 KPD kidney donors in the last year was conducted to identify and explore themes in decision making and risk taking. The pilot study was followed by the main study comprised of 20 recipients who had already undergone KPD transplantation and 20 donors who had undergone donor nephrectomy. We conducted semistructured interviews in this cohort and analyzed the data thematically. Each donor-recipient pair was interviewed together to facilitate dyadic conversation and provide deeper insight into the decision-making process leading to transplant and donation. RESULTS Common themes to both recipient and donor decision making included quality of life; characteristics of the unknown donor and post-transplant expectations. Recipient-specific themes included failure to reach life span milestones, experiences of fellow patients, and altruistic desire to expand the donor pool. Donor-specific themes included balancing existing life commitments with the recipient's need for a kidney, equity and mental accounting in kidney exchange (comparable quality of the kidney received versus the kidney donated), and logistical justice for the recipient. DISCUSSION Donors and recipients frame and weight the concepts of risk, justice, and equity differently. This may have direct implications to facilitating patient-centered communication and engagement in KPD pairs.
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Affiliation(s)
- L S Baines
- Faculty of Health Social Care & Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - H Dulku
- Imperial College Healthcare NHS Trust, Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - R M Jindal
- USU-Walter Reed Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA.
| | - V Papalois
- Imperial College Healthcare NHS Trust, Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
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24
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Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-Paired Donation to Increase Living Donor Kidney Transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017. Indian J Nephrol 2018; 28:1-9. [PMID: 29515294 PMCID: PMC5830802 DOI: 10.4103/ijn.ijn_365_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Artemis Hospital, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Anant Kumar
- Department of Transplantation Surgery, Max Group of Hospital, New Delhi, India
| | - Manish Rathi
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajkumar K. Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishan L. Gupta
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Shroff
- Department of Transplantation Surgery, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Sandip K. Saxena
- Department of Nephrology, Apollo Hospital, Indore, Madhya Pradesh, India
| | - Pankaj R. Shah
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Pranjal R. Modi
- Department of Transplantation Surgery Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vishwanath Billa
- Department of Nephrology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dhamedndra S. Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tarun K. Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | | | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Rajshekhar Perumalla
- Department of Transplantation Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India
| | - Manoj Jain
- Department of Renal Pathology Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael A. Rees
- Department of Transplantation Surgery, University of Toledo Medical Center, Toledo, Ohio
- CEO, Alliance for Paired Donation, USA
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25
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Cowan N, Gritsch HA, Nassiri N, Sinacore J, Veale J. Broken Chains and Reneging: A Review of 1748 Kidney Paired Donation Transplants. Am J Transplant 2017; 17:2451-2457. [PMID: 28489287 DOI: 10.1111/ajt.14343] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 01/25/2023]
Abstract
Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real-world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length.
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Affiliation(s)
- N Cowan
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
| | - H A Gritsch
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
| | - N Nassiri
- Department of Urology, University of Southern California, Los Angeles, CA
| | - J Sinacore
- Director of Education and Development, National Kidney Registry (NKR), Babylon, NY
| | - J Veale
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
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