Transplantation With Kidney Paired Donation to Increase the Donor Pool: A Single-Center Experience

Background. A living either related or unrelated donor transplant leads to a better outcome in terms of patient and graft survivals compared with one from a deceased donor. Desensitization protocols are expensive and labor intensive. The use of unrelated living donors has the greatest potential to increase the number of donors in the future, when no willing living donor is available due to blood group and/or human leukocyte antigen incompatibility. Herein, we have reported our results with a living donor exchange program. Aims. To determine the feasibility and effectiveness of kidney paired donation (KPD) to manage patients with incompatible donors as well as present patient and graft survivals, serum creatinine (S.Cr) levels, and rejection episodes. Results. Between June 2000 and December 2009, we performed KPD transplants in 36 recipients to avoid blood group incompatibility (n = 28) or to avoid a positive crossmatch (n = 8). At a median follow-up of 27.7 months (range, 5.83-119.8). The patient survival rate was 88.9% and the graft survival rate was 94.4%. Four patients developed acute cellular rejection episodes (11.1%) and 3 (8.3%) acute antibody-mediated rejection. At 1, 3, and 5 years, the mean S.Cr values were 1.42 +/- 0.28 mg% (n = 28) 1.61 +/- 0.51 (n = 22) and 1.24 +/- 0.15 (n = 8), respectively. Conclusions. The incidence of acute rejection episodes and patient/graft survivals were acceptable in our KPD program. The use of unrelated living donors has great potential to increase the number of donors in the future; a national KPD program should be encouraged in India.