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Background: Live donor kidney transplantation is considered the optimal choice for renal replacement therapy, providing established benefits, such as superior patient survival and improved quality of life. However, immunological challenges, including ABO blood group incompatibility and, particularly, donor‐specific HLA antibodies, may impact long‐term outcomes considerably or even prevent safe direct transplantation with the intended donor. Methods: In this review, the authors discuss kidney paired donation (KPD) as a viable strategy to overcome immunological barriers to living donation through organ exchanges. We thereby lay special focus on the Czech‐Austrian transnational KPD program. Results: While the benefits of KPD programs are well established for adult recipients, recent data suggest that this may hold true also for pediatric patients. Complex algorithms, considering factors like the intricate patterns of HLA sensitization, play a pivotal role in predicting suitable matches, but for pediatric patients also non‐immunological factors including age and weight match may play a role. As pool size proves crucial for program efficacy, several countries in Europe have now initiated transnational collaborations to maximize match rates. Among those, the Czech‐Austrian transnational joint program, established in 2015 and now expanded to a cooperation with the Israel transplant program to further increase transplant rates, represents a successful example. Conclusion: KPD programs, with their innovative approaches and international partnerships, hold promise for enhancing outcomes and addressing the increasing demand for kidney transplantation. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer- reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people’s wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Près d'un tiers des candidats au don de rein présente une incompatibilité (HLA et/ou ABO) avec le receveur pour lequel il s'engage. Le don croisé permet d'échanger des donneurs potentiels et donne l'accès à une greffe rénale compatible. La loi de bioéthique de 2011 a autorisé le don croisé en France avec une réciprocité entre 2 paires « donneur-receveur » incompatibles. Un faible nombre de greffes a été réalisé du fait d'une autorisation trop limitée en comparaison à d'autres pratiques européennes. Cette étude présente les perspectives de la nouvelle loi de bioéthique, promulguée en 2021, qui élargit les pratiques autorisées pour le don croisé en France. Les deux évolutions simulées sont l'augmentation du nombre de paires engagées dans un échange croisé à 6 (contre 2 paires actuellement) et le recours à un donneur décédé en substitution à l'un des donneurs vivants. Différents scénarii sont simulés à partir des données de l'Agence de la biomédecine ; les paires incompatibles inscrites dans le programme de don croisé en France entre décembre 2013 et février 2018 (78 paires incompatibles), les greffes incompatibles réalisées au cours de la même période (476 paires incompatibles) et les caractéristiques des donneurs décédés ainsi que les propositions faites sur cette période. L'augmentation du nombre de paires a un effet limité sur le nombre de greffes, qui passe de 18 (23 % des receveurs) dans le système actuel à 25 (32 % des receveurs) lorsque 6 paires peuvent être engagées dans un échange croisé. Le recours à un donneur décédé augmente significativement le nombre de greffes, qui passe à 41 (52 % des receveurs). Cette étude permet d'évaluer l'augmentation des possibilités de greffes rénales par don croisé suite à la nouvelle loi de bioéthique. Un groupe de travail et une campagne d'information des professionnels et des patients seront nécessaires pour sa mise en œuvre, dont les résultats seront d'autant plus importants que la participation sera élevée. Almost one third of kidney donation candidates are incompatible (HLA and/or ABO) with their directed recipient. Kidney paired donation allows potential donors to be exchanged and gives access to a compatible kidney transplant. The Bioethics Law of 2011 authorised kidney paired donation in France with reciprocity between 2 incompatible "donor-recipient" pairs. A limited number of transplants have been performed due to a too restricted authorization compared to other European practices. This study presents the perspectives of the new Bioethics Law, enacted in 2021, which increases the authorised practices for kidney paired donation in France. The two simulated evolutions are the increase of the number of pairs involved in a kidney paired donation to 6 (against 2 currently) and the use of a deceased donor as a substitution to one of living donor. Different scenarios are simulated using data from the Agence de la Biomedecine ; incompatible pairs registered in the kidney paired donation programme in France between December 2013 and February 2018 (78 incompatible pairs), incompatible transplants performed during the same period (476 incompatible pairs) and characteristics of deceased donors as well as proposals made over this period. Increasing the number of pairs has a limited effect on the number of transplants, which increases from 18 (23% of recipients) in the current system to 25 (32% of recipients) when 6 pairs can be involved. The use of a deceased donor significantly increases the number of transplants to 41 (52% of recipients). This study makes it possible to evaluate the increase in possibilities of kidney transplants by kidney paired donation following the new bioethics law. A working group and an information campaign for professionals and patients will be necessary for its implementation. [ABSTRACT FROM AUTHOR]

Introduction: Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients' and donors' decision-making about donation, the educational content they received, and their recommendations for educational improvements. Method: We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). Findings: Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators' helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. Discussion: Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making. [ABSTRACT FROM AUTHOR]

As a result of the increasing number of transplants being facilitated by kidney paired donation and newer initiatives such as voucher donation, end-chain (EC) kidneys now constitute a considerable proportion of kidney paired donation transplants in the United States. Data on EC kidneys are limited. They may be lower in quality compared with non-EC living donor kidneys. However, they can provide unique opportunities for recipient candidates without living donors. There are no data or algorithms available to guide recipient selection for EC kidneys accepted by a transplant center. Considering the ethical principles of utility, justice, and respect for persons that underlie organ allocation, we discuss 3 potential approaches for recipient selection: (1) adherence to the kidney allocation system, (2) utility maximization; and (3) priority to high-risk candidates, along with examples from our own center's experience. Similar considerations are also relevant to selection of recipients for nondirected donor organs and to out-of-sequence allocation for deceased organ donors. Because EC kidneys represent an increasing proportion of kidney paired donation-facilitated living kidney donor transplantation in the United States and will likely get more medically and surgically complex over time, ongoing research on their utilization and outcomes is needed., Competing Interests: Declaration of competing interests The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. C.T. is a member of the OPTN MPSC, the ASTS Ethics Committee, the TTS Ethics Committee, and AST PSECOP Executive Committee. The views expressed in this manuscript are her own and do not necessarily reflect the official policy or position of the Organ Procurement and Transplantation Network (OPTN), nor any other organization with which she is affiliated., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Copyright of State & Society / Państwo i Społeczeństwo is the property of Andrzej Frycz Modrzewski Krakow University, AFM Publishing Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Kidney Transplantation is the best as well as the most cost-effective mode of renal replacement therapy for end end-stage renal disease patients with better survival and quality of life compared to dialysis. In the absence of a deceased donor programme in Chhattisgarh, Kidney paired donation (KPD) may provide an important strategy for easing the crisis in organ availability. In KPD, the incompatibility problems with two donor– recipient pairs can be solved by exchanging donors. We report our first successful KPD transplantation done by our institute in Chhattisgarh. Out of two, one had acute graft dysfunction which gets recovered after stopping tacrolimus and converting to sirolimus. Both the donors had a smooth hospital course and were discharged on the 5th postoperative day. They are in follow- up with us with good graft function (serum creatinine 1.2 mg/dl and 0.8 mg/dl). In the era of organ shortage, KPD provides hope to the growing number of patients suffering from end-stage renal disease in Chhattisgarh which will promote renal transplantation in our state.

Blood group and tissue incompatibilities remain significant barriers to achieving transplantation. Although no patient should be labeled “un-transplantable” due to blood group or tissue incompatibility, all candidates should be provided with individualized and realistic counseling regarding their anticipated wait times for deceased donor or kidney paired donation matching, with early referral to expert centers for desensitization when needed. Vital is the careful selection of patients whose health status is such that desensitizing treatment is less likely to cause serious harm and whose anti-HLA antibody status is such that treatment is likely to accomplish the goal of increasing organ offers with an acceptable final crossmatch. Exciting new developments have re-energized the interest and scope of desensitization in the times ahead.

Blood group and tissue incompatibilities remain significant barriers to achieving transplantation. Although no patient should be labeled "un-transplantable" due to blood group or tissue incompatibility, all candidates should be provided with individualized and realistic counseling regarding their anticipated wait times for deceased donor or kidney paired donation matching, with early referral to expert centers for desensitization when needed. Vital is the careful selection of patients whose health status is such that desensitizing treatment is less likely to cause serious harm and whose anti-HLA antibody status is such that treatment is likely to accomplish the goal of increasing organ offers with an acceptable final crossmatch. Exciting new developments have re-energized the interest and scope of desensitization in the times ahead. [ABSTRACT FROM AUTHOR]

Major advancements in the development of HLA antibody detection techniques and our understanding of the outcomes of solid organ transplant in the context of HLA antibody have occurred since the relevance of sensitization was first recognized nearly 50 years ago. Additionally, kidney paired donation programs (KPD) have become widespread, deceased donor allocation policies have changed, and several new therapeutic options have become available with promise to reduce HLA antibody. In this overview we aim to provide thoughtful guidance about when desensitization in kidney transplantation should be considered taking into account the outcomes of HLA incompatible transplantation. Novel therapeutics, desensitization endpoints, and strategies for future study will also be discussed. While most of our understanding about desensitization comes from studying kidney transplant candidates and recipients, many of the concepts discussed can be easily applied to desensitization in all of solid organ transplantation. [ABSTRACT FROM AUTHOR]

Kidney paired donation is the most cost-effective approach in incompatible donor-recipient pairs. Incompatibility may be due to blood group, human leucocyte antigen crossmatch or both. In many cases of a living donor kidney transplant, there is only one potential donor who becomes unsuitable due to any of the above mentioned factors. In kidney paired donation, donor-recipient pairs are exchanged to sort out the incompatibility. We report our first successful three-way kidney exchange transplantation from North India. As deceased donor program is still in evolving stage in most parts of our country and transplant with desensitization protocol is associated with financial constraints, infections, and lack of availability in many centers, kidney paired donation is a valuable approach to expand the donor pool. [ABSTRACT FROM AUTHOR]

Summary: Antibody incompatibility is a barrier to living kidney transplantation; antibody incompatible transplantation (AIT) is an accepted treatment modality, albeit higher risk. This study aims to determine changes to clinical decision making and access to AIT in the UK. An electronic survey was sent to all UK renal transplant centres (n = 24), in 2014, and again in 2018. Questions focused on entry & duration in the UKLKSS for HLA and ABO‐incompatible pairs, Can and provision of direct AIT transplantation within those centres. Between 2014 & 2018, the duration recommended for patients in the UKLKSS increased. In 2014, 34.8% of centres reported leaving HLA‐i pairs in the UKLKSS indefinitely, or reviewing on a case by case basis, by 2018 this increased to 61%. Centres offering direct HLA‐i transplantation reduced from 58% to 37%. For low titre (1:8) ABO‐i recipients, 66% of centres recommended at least 9 months (3 matching runs) in the UKLKSS scheme in 2018, compared to 47% in 2014, 50% fewer units consider direct ABO‐i transplantation for unsuccessful pairs with high ABO titres (>1:512). Over time, clinicians appear to be facilitating more conservative management of AIT patients, potentially limiting access to living donor transplantation. [ABSTRACT FROM AUTHOR]

Summary: Kidney paired donation (KPD) is a valuable tool to overcome immunological barriers in living donor transplantation. While small national registries encounter difficulties in finding compatible matches, multi‐national KPD may be a useful strategy to facilitate transplantation. The Czech (Prague) and Austrian (Vienna) KPD programs, both initiated in 2011, were merged in 2015. A bi‐national algorithm allowed for ABO‐ and low‐level HLA antibody‐incompatible exchanges, including the option of altruistic donor‐initiated domino chains. Between 2011 and 2019, 222 recipients and their incompatible donors were registered. Of those, 95.7% (Prague) and 67.9% (Vienna) entered into KPD registries, and 81 patients received a transplant (95% 3‐year graft survival). Inclusion of ABO‐incompatible pairs in the Czech program contributed to higher KPD transplant rates (42.6% vs. 23.6% in Austria). After 2015 (11 bi‐national match runs), the median pool size increased to 18 pairs, yielding 33 transplants (8 via cross‐border exchanges). While matching rates doubled in Austria (from 9.1% to 18.8%), rates decreased in the Czech program, partly due to implementation of more stringent HLA antibody thresholds. Our results demonstrate the feasibility of merging small national KPD programs to increase pool sizes and may encourage the implementation of multi‐national registries to expand the full potential of KPD. [ABSTRACT FROM AUTHOR]

Kidney Transplantation is the best as well as the most cost-effective mode of renal replacement therapy for end end-stage renal disease patients with better survival and quality of life compared to dialysis. In the absence of a deceased donor programme in Chhattisgarh, Kidney paired donation (KPD) may provide an important strategy for easing the crisis in organ availability. In KPD, the incompatibility problems with two donor– recipient pairs can be solved by exchanging donors. We report our first successful KPD transplantation done by our institute in Chhattisgarh. Out of two, one had acute graft dysfunction which gets recovered after stopping tacrolimus and converting to sirolimus. Both the donors had a smooth hospital course and were discharged on the 5th postoperative day. They are in follow- up with us with good graft function (serum creatinine 1.2 mg/dl and 0.8 mg/dl). In the era of organ shortage, KPD provides hope to the growing number of patients suffering from end-stage renal disease in Chhattisgarh which will promote renal transplantation in our state. [ABSTRACT FROM AUTHOR]

Summary: 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. [ABSTRACT FROM AUTHOR]

Kidney exchanges were developed to match kidney failure patients with willing but incompatible donors to other donor-patient pairs. Finding a match in a large candidate pool can be modeled as an integer program. However, these exchanges accumulate participants with characteristics that increase the difficulty of finding a match and, therefore, increase patients' waiting time. Therefore, we sought to fine-tune the formulation of the integer program by more accurately assigning priorities to patients based on their difficulty of matching. We provide a detailed formulation of prioritized kidney exchange and propose a novel prioritization algorithm. Our approach takes advantage of the global knowledge of the donor-patient compatibility within a pool of pairs and calculates an iterative, paired match power (iPMP) to represent the donor-patient pairs' abilities to match. Monte Carlo simulation shows that an algorithm using the iPMP reduces the waiting time more than using paired match power (PMP) for the difficult-to-match pairs with hazard ratios of 1.3480 and 1.1100, respectively. Thus, the iPMP may be a more accurate assessment of the difficulty of matching a pair in a pool than PMP is, and its use may improve matching algorithms being used to match donors and recipients. [ABSTRACT FROM AUTHOR]

Summary: Baseline predonation estimated GFR (eGFR) appears to predict the risk of postdonation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90 ml/min/1.73 m2 as an acceptable level of glomerular filtration rate (GFR) for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80 ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1‐year follow‐up linking records in the AKX database and ANZDATA. There were 73 male and 56 female donors; mean (±SD) age was 53 ± 11 years. Predonation eGFR was 94 ± 13 ml/min/1.73 m2, mGFR 99 ± 17 ml/min/1.73 m2 and raw mGFR 108 ± 18 ml/min. Baseline eGFR was <80 ml/min/1.73 m2 in 19 donors, and <90 ml/min/1.73 m2 in 42 donors. At 1 year postdonation eGFR was 68 ± 15 ml/min/1.73 m2 and the predicted eGFR at 30 years postdonation was on average 50 (29–83) ml/min/1.73 m2. The hypothetical mean age at end‐stage kidney disease was estimated to be 145 (95% CI 120–263) years. Over 30% of AKX live donors would have been excluded from donation using KDIGO guidelines. Using AKX donor guidelines, the majority of donors with predicted eGFR <30 ml/min/1.73 m2 30‐year postdonation were aged ≥50 years. Long‐term outcome data on AKX donors with low eGFR will need careful monitoring. [ABSTRACT FROM AUTHOR]

Abstract Kidney paired donation is a partial solution to overcoming biological incompatibility preventing kidney transplants. A kidney paired donation (KPD) program consists of altruistic or non-directed donors (NDDs) and pairs, each of which comprises a candidate in need of a kidney transplant and her/his willing but incompatible donor. Potential transplants from NDDs or donors in pairs to compatible candidates in other pairs are determined by computer assessment, though various situations involving either the donor, candidate, or proposed transplant may lead to a potential transplant failing to proceed. A KPD program can be viewed as a directed graph with NDDs and pairs as vertices and potential transplants as edges, where failure probabilities are associated with each vertex and edge. Transplants are carried out in the form of directed cycles among pairs and directed paths initiated by NDDs, which we refer to respectively as cycles and chains. Previous research shows that selecting disjoint subgraphs with a view to creating fallback options when failures occur generates more realized transplants than optimal selection of disjoint chains and cycles. In this paper, we define such subgraphs, which are called locally relevant (LR) subgraphs, and present an efficient algorithm to enumerate all LR subgraphs. Its computational efficiency is significantly better than the previous, more restrictive, algorithms. [ABSTRACT FROM AUTHOR]

Kidney paired donation (KPD) is a major innovation that is changing the landscape of kidney transplantation in the United States. We used the 2006-2021 United Network for Organ Sharing data to examine trends over time. KPD is increasing, with 1 in 5 living donor kidney transplants (LDKTs) in 2021 facilitated by KPD. The proportion of LDKT performed via KPD was comparable for non-Whites and Whites. An increasing proportion of KPD transplants are going to non-Whites. End-chain recipients are not identified in the database. To what extent these trends reflect how end-chain kidneys are allocated, as opposed to increase in living donation among minorities, remains unclear. Half the LDKT in 2021 in sensitized (panel reactive antibody ≥ 80%) and highly sensitized (panel reactive antibody ≥ 98%) groups occurred via KPD. Yet, the proportion of KPD transplants performed in sensitized recipients has declined since 2013, likely due to changes in the deceased donor allocation policies and newer KPD strategies such as compatible KPD. In 2021, 40% of the programs reported not performing any KPD transplants. Our study highlights the need for understanding barriers to pursuing and expanding KPD at the center level and the need for more detailed and accurate data collection at the national level., (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Novel strategy in living donor kidney transplantation to outcome biological barriersLiving donor kidney transplantation (LKD) is considered the best type of transplant for end-stage renal disease patients in terms of organ quality and survival. However, ABO incompatibility and positive cross-match remain the most frequent immunological barriers. The novel strategy of kidney paired donation (KPD) has been proposed to facilitate transplantation in patients who have a healthy and willing donor but present this type of barriers.The first experiences of KPD in a single centre were carried out by creating large regional or national registries that increase the choice in difficult-to-match patients. Our experience shows that referring to the National Italian Registry for identifying a correct pair, allows performing KPD with good outcomes of LKD in cases that would otherwise not be feasible. [ABSTRACT FROM AUTHOR]

Introduction: Highly sensitized patients awaiting a kidney transplant accrue on the transplant waiting list. The breadth of HLA antibodies in this subpopulation of patients precludes receiving a compatible organ offer through regular allocation within an acceptable time-frame. Areas covered: Several alternative options to receive a transplant exist for these patients, including additional priority in regular allocation, special programs based on allocation through acceptable antigens, kidney paired donation programs, desensitization protocols, or a combination of the latter two. In this review, these options and their outcomes are discussed as well as some possibilities to further enhance transplantation of this disadvantaged group of patients. Expert commentary: For highly sensitized patients, special attention is required, for which several strategies may apply. A step-wise approach may be the optimal strategy to facilitate successful transplantation of highly sensitized patients. [ABSTRACT FROM AUTHOR]

In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate, or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD. Exact expected utility calculations for these sets are compared to estimates based on Monte Carlo samples of the underlying network. Models and methods are extended to include transplant candidates who join KPD with more than one incompatible donor. Microsimulations demonstrate the superiority of accounting for failure probability and fallback options, as well as candidates joining with additional donors, in terms of realized transplants and waiting time for candidates. [ABSTRACT FROM AUTHOR]

Background: The Australian kidney paired donation program adopted the principles of within‐chain simultaneous live donor surgery and of organ transport, with the requirement of keeping cold ischemia time (CIT) to <12 h. Whether these principles could be adhered to and what impact on transplant outcome they might have is unknown. Methods: We evaluated the logistic challenges and outcomes of the first 100 kidney transplants performed in the Australian kidney paired donation program. Results: Within 4 years, 17 donor surgeons at 12 centres were involved in 37 chain exchange surgeries. Sixteen kidneys were transplanted at the same hospital and 84 required transport to the recipient hospital. Mean (±SD) within chain anaesthetic induction time variability was 8 ± 18 min and mean individual surgeon operating time was 115 ± 44 min. In two cases, delays during donor surgery resulted in increased CIT by 1 h because of deferred transport. CIT was 2.6 ± 0.6 h for non‐shipped and 6.8 ± 2.8 h for shipped kidneys, four kidneys had CIT of 12–14 h. Immediate allograft function was observed in 85% of recipients, with no difference between shipped and non‐shipped kidneys. There were only two cases of delayed graft function requiring temporary dialysis; both had CIT <7 h. There was no difference in serum creatinine at 1 month between non‐shipped and shipped kidneys (105 ± 26 versus 112 ± 50 µmol/L) and allograft survival at 1 year was 97%. Conclusion: The study provided a favourable audit of kidney transplant activity, despite challenges of simultaneous surgery, organ transport coordination and prolonged CIT. The decision to ship donor kidneys rather than the donor was demonstrated to be feasible and safe. [ABSTRACT FROM AUTHOR]

Background. To ascertain the validity of kidney paired donations (KPDs) as an alternative strategy for increasing living donor kidney transplantations (LDKTs) in an LDKT-dominated transplant programme since directed kidney transplantation, ABO-incompatible or crossmatch-positive pairs are not feasible due to costs and infectious complications. Methods. This was a prospective single-centre study of 77 KPD transplantations (25 two-way, 7 three-way and 1 six-way exchange) from 1 January 2015 to 1 January 2016 of 158 registered donor recipient pairs. During this period, a total of 380 kidney transplantations [71 deceased donor kidney transplantations (DDKTs), 309 LDKTs] were performed. The reasons for opting for KPD were ABO incompatibility (n=45), sensitization (n=26) and better matching (n=6). Results. KPD matching was facilitated in 62% (n=98) of transplants. In all, 48.7% (n=77) of the transplants were completed in 2015, whereas 13.3% (n=21) of the matched patients were to undergo transplant surgery in early 2016 after getting legal permission. The waiting time for KPD was shorter compared with DDKT. The death-censored graft survival and patient survival were 98.7% (n=76) and 93.5% (n=72), respectively. In all, 14.2% (n=11) of patients had acute rejection. Match rates among sensitized (n=60) and O group patients (n=62) were 58.3% (n=35) and 41.9% (n=26), respectively. Of these, 43.3% (n=26) and 29% (n=18) of transplants were completed and 15% (n=9) and 12.9% (n=8), respectively, are waiting for legal permission. Conclusions. LDKT increased by 25% in 1 year in our single-centre KPD programme. Our key to success was the formation of a KPD registry, awareness and active counselling programs and developing a dedicated team. [ABSTRACT FROM AUTHOR]

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]

Growing incidence of end-stage renal disease, shortage of kidneys from deceased donors and a better outcome for recipients of kidneys from living donor have led many centres worldwide to favour living donor kidney transplantation programmes. Although criteria for living donation have greatly evolved in recent years with acceptance of related and unrelated donors, an immunological incompatibility, either due to ABO incompatibility and/or to positive cross-match, between a living donor and the intended recipient, could impede up to 40% of such procedures. To avoid refusal of willing and healthy living donors, a number of strategies have emerged to overcome immunological incompatibilities. Kidney paired donation is the safest way for such patients to undergo kidney transplantation. Implemented with success in many countries either as national or multiple regional independent programmes, it could include simple exchanges between any number of incompatible pairs, incorporate compatible pairs and non-directed donors (NDDs) to start a chain of compatible transplantations, lead to acceptance of ABO-incompatible matching, and integrate desensitising protocols. Incorporating all variations of kidney paired donation, the Australian programme has been able to facilitate kidney transplantation in 49% of registered incompatible pairs. This review is a plea for implementing a national kidney paired donation programme in Switzerland.

To assess the impact of shipping distance and cold ischaemia time (CIT) of shipped organs in a kidney paired donation (KPD) programme, we evaluated the outcomes of the initial 100 kidney transplants performed in the Australian KPD programme. In a 44-month period, 12 centres were involved in fifteen 2-way, twenty 3-way, one 4-way and one 6-way exchanges. Sixteen kidneys were transplanted at the same hospital (CIT 2.6 ± 0.6 h) and 84 required transport to the recipient hospital (CIT 6.8 ± 2.8 h). A spontaneous fall in serum creatinine by at least 10% within 24 h was observed in 85% of recipients, with no difference between nonshipped and shipped kidneys. There were two cases of transient delayed graft function requiring dialysis and patient and graft survival at 1 year were 99% and 97%, respectively. There was no difference in recipients of nonshipped compared with shipped kidneys with regard to serum creatinine at 1 month (mean difference (MD) 7.3 μmol/l, 95% CI −20.2 to 34.8, P = 0.59), 1-year graft survival (MD 3.9%, 95% CI −5.4 to 13.2, P = 0.41) or patient survival (MD −2.4%, 95% CI −10.0 to 5.2, P = 0.54). Despite prolonged CIT for interstate exchanges, the programme's decision to ship donor kidneys rather than the donor appears to be safe. [ABSTRACT FROM AUTHOR]