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In a living donor kidney transplantation ( LDKT) dominated transplant programme, kidney paired donation ( KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation ( DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility ( n = 222), positive cross-match ( n = 59) and better matching ( n = 19). A total of 124 two-way ( n = 248), 14 three-way ( n = 42), one four-way ( n = 4) and one six-way exchange ( n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% ( n = 288) and 83.3% ( n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. [ABSTRACT FROM AUTHOR]

Introduction: Paired-kidney exchange (PKE) is used in western countries to increase donor pool. In India, there are not many centers involved in PKE program. We present 10 years of this experience and outcome of the recipients. Materials and Methods: Between year 2000 and 2009, 34 transplants with PKE were performed. All donors were live related, and permission from Authorization committee(s) from one or more states was obtained prior to transplantation. Both donor and recipient surgeries were carried out simultaneously in all cases at a single institution. Last 10 donors were offered laparoscopic donor nephrectomy and all other previous donors were operated by open surgery. Results: Five donor-recipient pairs were from the state of Rajasthan, one from Madhya Pradesh, and all others from Gujarat. ABO incompatibility between donor and recipient was present in 12 pairs and positive lymphocyte cross-match in 5 pairs. Conclusion: Paired-kidney-exchange transplantation expands donor pool and total number of transplantation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Comparison of time on the deceased donor kidney waitlist versus time on the kidney paired donation registry in the Australian program," by Ferrari P and colleagues in the 2012 issue.