Crossing borders to facilitate live donor kidney transplantation: the Czech‐Austrian kidney paired donation program – a retrospective study

Abstract

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, multinational 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 donorinitiated 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 multinational registries to expand the full potential of KPD.

Predictive Potential of Flow Cytometry Crossmatching in Deceased Donor Kidney Transplant Recipients Subjected to Peritransplant Desensitization

“…Of note, described the poor outcome of HLA incompatible transplantation with pretransplant FCXM positivity justifies longer waiting time for more compatible donors as there is a lack of available organs and better allocation would finally increase the patient-years with functioning grafts. Some of those sensitized patients may also find their compatible donor in the case of kidney pair donation when a living donor is available ( 32 ).…”

Non‐simultaneous kidney exchange cycles in resource‐restricted countries without non‐directed donation – a prospective single‐center cohort study

“…The other alternatives to NSKEC in the near future would be involvement of other transplant units and shipping of donor kidneys to increase surgical resources and thus facilitate simultaneous KPD transplants (as it is routine in the United States or in some European programs, such as the Czech-Austrian program [36].…”

Is it the time to apply the model of Czech‐Austrian kidney paired donation program?

“…The recent article of the Journal presented perfect example how small KPD/KEP programs, the originally separated Czech and Austrian kidney paired donation programs, have been merged to increase pool sizes [8]. The first step of their collaboration was a cross‐border trans‐national exchange in 2016 between Institute for Clinical and Experimental Medicine, Prague and Medical University of Vienna, followed by the merge of their pools for common match runs [9].…”

“…The first step of their collaboration was a cross‐border trans‐national exchange in 2016 between Institute for Clinical and Experimental Medicine, Prague and Medical University of Vienna, followed by the merge of their pools for common match runs [9]. The current article of the Journal presents the result of 81 KPD transplants performed in this program [8]. Almost 25% of these transplantations have been performed pre‐emptively.…”

“…Overall 1‐ and 3‐year graft survival was 96% and 95%, and median serum creatinine was 1.35 and 1.30 mg/dl, respectively. Nine patients were diagnosed with ABMR (four after desensitization for preformed DSA) and 15 patients with T cell‐mediated rejection and nine with ABMR [8].…”