Published online Nov 6, 2016. doi: 10.5527/wjn.v5.i6.531
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
To avoid desensitization protocols and ABO incompatible kidney transplantation (KT) due to high costs and increased risk of infections from intense immunosuppression.
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.
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.
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.
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.