Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India

Table 1 Demographic of patients

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6
Age (yr)	17	38	45	40	25	45
Gender	Male	Male	Male	Male	Male	Male
Original disease	CGN	HT	HT	ADPKD	HT	DM
ABO group	A	B	AB	AB	B	A
Dialysis	12 mo	8 mo	7 mo	18 mo	7 mo	3 mo
Weight (kg)	40	44	59	68	43	55
Original donor relation	Father	Wife	Wife	Wife	Mother	Wife
Reason for joining KPD
Sensitized	Yes	Yes	Yes	Yes	Yes	No
ABO incompatible						Yes
Time from KPD registration to find donor	2 wk	1 d	2 wk	6 mo	4 wk	1 mo
Time from donor to KT	58 d	60 d	55 d	75 d	48 d	60 d
With original donor
LCM (%)	80/80/90	5/5/7	5/0/5	80/80/90	12/7/25
FCM (MCS)	260/298	Neg/236	80/159	150/250	N/N
DSA class 1 (MFI)	A1 = 8000	No DSA	B44 = 4188	A11 = 10000	BW4 = 5000
	B57 = 6200		A31 = 1100	B57 = 12645
				BW4 = 12645
DSA class 2 (MFI)	DQ7 = 1600, DQ9 = 2200	DQ2 = 9000	No DSA	No DSA	DR13 = 7000
With cross donor
LCM (%)	Neg/neg/neg	15/15/20	Neg/neg	Neg/Neg/Neg	5/12/2010	Neg/Neg/Neg
FCM (MCS)	Neg/neg	Neg/200	Neg/neg	Neg/Neg	Neg/Neg	Neg/Neg
DSA class 1	No DSA	No DSA	No DSA	No DSA	No DSA	No DSA
DSA class 2	No DSA	No DSA	No DSA	No DSA	No DSA	No DSA
Desensitization	Yes	Yes	Yes	No	No	No
State	Gujarat	Rajasthan	Gujarat	Gujarat	Rajasthan	Rajasthan

CGN: Chronic glomerulonephritis; ADPKD: Autosomal dominant polycystic kidney disease; Neg: Negative; LCM: Lymphocyte cross match; FCM: Flow cross match; DSA: Donor specific antibody; MCS: Median channel shift; MFI: Mean fluorescent intensity; HT: Hypertension; DM: Diabetes mellitus; KT: Kidney transplant; KPD: Kidney paired donation.

Table 2 Desensitisation protocol and outcome

	Patient 1	Patient 2	Patient 3
Before desensitization with original donor
LCM/DTT/AHG (%)	80/80/90	5/5/7	5/0/5
T/B FCM (MCS)	260/298	Neg/236	80/159
DSA class 1	A1 = 8000, B57 = 6200	No DSA	B44 = 4188, A31 1100
DSA class 2	DQ7 = 1600, DQ9 = 2200	DQ2 = 9000	No DSA
DP	8TPE + 8Bort/MP/IVIG + TAC/MMF	9TPE + 6Bort/MP/IVIG + R + TAC/MMF	4TPE + 4Bort/MP/IVIG + TAC/MMF
After desensitization with original donor
LCM	80/80/90	17/15/20	5/0/7
FCM	254/333	Neg/504	Neg/129
DSA class 1	A1 = 2000, B57 = 5500	No DSA	B44 = 4622, A31 = 1400
DSA class 2	DQ7 = 2000, DQ9 = 2000	DQ2 = 12000	No DSA
Side effects	Tuberculosis	Graft nephrectomy	Tuberculosis

TPE: Plasmapheresis; Bort: Bortezomib; MP: Methyl prednisolone; IVIG: Immunoglobulin; R: Rituximab; TAC: Tacrolimus; MMF: Mycophenolate mofetyl; DP: Desensitization protocol; LCM: Lymphocyte cross match; FCM: Flow cross match; DSA: Donor specific antibody; Neg: Negative; MCS: Median channel shift; DTT: Dithiothreitol; AHG: Antihuman globulin test.

Table 3 Human leukocyte antigen data of patients and donors

	A		B		Bw		Cw		DR B1		DR B3,4,5		DQ B1
P1	2	29	44	-	4	-	7	15	4	15	51	53	4	6
D1	1	29	44	57	4	-	6	15	7	15	51	53	6	9
P2	2	33	40	44	4	6	7	15	10	15	51	-	5	6
D2	33	-	8	58	4	6	3	7	17	-	52	-	2	-
P3	2	11	35	52	4	6	12	-	4	15	51	53	6	8
D3	31	33	44	52	4	-	7	12	4	15	51	53	6	8
P4	24	32	18	35	6	-	4	7	11	15	51	52	6	7
D4	11	32	8	57	4	6	6	7	13	15	51	52	6	-
P5	24	33	8	35	6	-	4	7	17	-	52	-	2	-
D5	24	32	8	49	4	6	7	-	13	17	52	-	2	6
P6	11	24	13	56	4	6	3	4	15	17	51	52	2	5
D6	1	68	75	70	6	0	7	8	10	11	52	0	5	7

Table 4 Demographic of donor data

	Donor 1	Donor 2	Donor 3	Donor 4	Donor 5	Donor 6
Age (yr)	46	38	40	38	45	35
Gender	Male	Female	Female	Female	Female	Female
Weight (kg)	44	50	50	50	60	82
ABO group	A1	B	A	B	B	B
GFR (R/L)	54/61	50/50	47/55	55/55	56/50	52/49
Creatinine (mg/dL)	0.8	0.7	0.5	0.6	0.6	0.8
Renal vessel (R/L)	2A2V/1A1V	1A1V/1A1V	1A1V/1A1V	1A1V/2A1V	1A2V/1A1V	1A1V/1A1V
LDN side	L	L	L	L	L	L

GFR: Glomerular filtration rate; LDN: Laparoscopic donor nephrectomy; R: Right; L: Left; A: Artery; V: Vein.

Table 5 Surgical details and outcome

Patient	1	2	3	4	5	6
WIT (s)	113	120	137	97	136	85
CIT (min)	50	150	85	136	73	60
AT (min)	31	27	24	40	25	14
UO (mL)	1100	1200	600	700	1000	950
Robotic KT	Yes	Yes	Yes
Open KT				Yes	Yes	Yes
LDN	Yes	Yes	Yes	Yes	Yes	Yes
KT date (2015)	17-Aug	21-Aug	17-Aug	18-Aug	18-Aug	7-Sep
Thymoglobulin (mg)	No	50	25	75	75	75
Creatinine (mg/dL)	0.7	0.7	1	0.7	1	1.1

WIT: Warm ischemia time; CIT: Cold ischemia time; AT: Anastomosis time; UO: Intra-operative urine output; LDN: Laparoscopic donor nephrectomy; KT: Kidney transplant.