Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

Kute, Vivek B.; Patel, Himanshu V.; Shah, Pankaj; Modi, Pranjal; Shah, Veena R; Rizvi, Syed Jamal; Pal, Bipin Chandra; Modi, Manisha P; Shah, Parth; Varyani, Umesh; Wakhare, Pavan S; Shinde, Saiprasad G; Ghodela, Viajay A; Patel, Minaxi H; Trivedi, Varsha B; Trivedi, Hargovind L

doi:10.12998/wjcc.v4.i10.351

Cited by 9 publications

(15 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Internet‐based communication tools should be used to connect with other incompatible pairs . Our report showed that different KPD forms (Table ) can be successfully applied in any country with limited resources .…”

Section: Discussionmentioning

confidence: 91%

“…There is an accumulation of difficult‐to‐match pairs (for example, blood type O patients and non‐O donors). Compatible pairs ; combining KPD with desensitization or ABOiKT; expanding the number of acceptable mismatches; national , international and global kidney exchange ; the use of A2 donor to O patient such as in the Methodist KPD programme ; and computer allocations will improve the quality and quantity of match and transplant rates for difficult‐to‐match pairs. Internet‐based communication tools should be used to connect with other incompatible pairs .…”

Section: Discussionmentioning

confidence: 99%

“…A large‐volume transplant centre can employ a single‐centre KPD programme when national programmes do not exist. A single‐centre KPD programme is easy and less costly than the national KPD programme ; it avoids challenges for the travelling donor due to variability between donor work up and donor surgery and eliminates potential barriers in multicentre programmes, such as donor travel, shipping of kidney, follow‐up care and disparity in healthcare cost and quality. Smaller centres should initially focus on easy‐to‐match pairs and employ multicentre KPD programmes to reduce waiting time and improve the quality and quantity of matches.…”

Section: Discussionmentioning

confidence: 99%

“…KPD is underutilized in India due to the lack of a KPD registry in the national programme; a lack of single‐centre KPD practice; a lack of harmony and coordination among different transplant units; variable healthcare costs and quality; a lack of uniform evaluation and follow‐up care for transplant patients and donors; inefficient matching algorithms; and legal, regulatory, logistical and economic barriers. Our centre in Ahmedabad, India, has pioneered KPD transplantation over the last few years . KPD has increased access to LDKT in national and single‐centre programmes across the world .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…We have previously reported 2-way and 3-way KE combined with desensitization protocols to increase access to LDKT for sensitized recipients. 9,10 Recipient 1 was highly sensitized and unlikely to undergo LDKT with KE alone. He was able to undergo LDKT with a combination of KE and desensitization therapy.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Kute

Patel²,

Shah³

et al. 2018

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: This study reports our experience of the first 4-way kidney exchange transplant combined with desensitization in India, which allows increased access to living-donor kidney transplant for sensitized patients. Patient and graft survival rates were both 100%. Conclusions: To the best of our knowledge, this is the first single-center report of 4-way kidney exchange transplant combined with desensitization from India. This procedure has the potential to expand livingdonor kidney transplant in disadvantaged groups (eg, sensitized patients). Recipients who are hard to match due to high panel reactive antibody and difficult to desensitize due to strong donor-specific antibodies can receive a transplant with a combination of kidney exchange and desensitization. Our study suggests that 4-way kidney exchange transplant can be performed in developing countries (India) similar to that shown in programs in developed countries with team work, kidney exchange registry, and counseling. Materials and Methods Key words: ABO incompatible, Blood group incompatibility, Kidney transplantation, Living donor, Paired exchange, Sensitized patients IntroductionKidney exchange (KE) is well established in the developed world but is now being slowly expanded in developing countries such as India. 1-7 Traditional 2-way KE, which is the most commonly performed KE (> 80%) in Indian KE transplant programs, has inherent limitations for quality and quantity of matching, mainly in disadvantaged groups like sensitized and O blood group patients. Kidney transplant options for sensitized patients include the use of a compatible donor recipient pair (DRP) or longer KE donor chains, acceptable mismatch KE, international KE, KE combined with desensitization or ABO-incompatible transplant (ABOiKT), living-to deceased-donor exchange, and deceased-donor kidney transplant (DDKT). The optimal donor chain length for KE programs is 3 in the developed world 8 ; however, this is not clear for developing countries like India. Longer KE donor chains with their inherent logistic and regulatory burdens do not lead to significantly more transplant procedures.Here, we report our experience of the first 4-way KE transplant combined with desensitization in India. The simultaneous surgeries involving 4 living

show abstract

Seventy-seven kidney paired donation transplantations at a single transplant centre in India led to an increase in living donor kidney transplantations in 2015

Kute

Patel

Shah

et al. 2017

Clinical Kidney Journal

View full text Add to dashboard Cite

BackgroundTo 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.MethodsThis 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).ResultsKPD 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.ConclusionsLDKT 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.

show abstract

Increasing access to kidney transplantation for sensitized recipient through three-way kidney paired donation with desensitization: The first Indian report

Cited by 9 publications

References 16 publications

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study

Untitled

Seventy-seven kidney paired donation transplantations at a single transplant centre in India led to an increase in living donor kidney transplantations in 2015

Contact Info

Product

Resources

About