The Canadian Kidney Paired Donation Program

Cole, Edward; Nickerson, Peter; Campbell, Patricia; Yetzer, Kathy; Lahaie, Nick; Zaltzman, Jeffery; Gill, John S.

doi:10.1097/tp.0000000000000455

Cited by 48 publications

(20 citation statements)

References 14 publications

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“…During the last 15 years there has been a substantial effort to increase live donor kidney transplantation through KPD, beginning as single center internal swaps to organized networks such as the NKR [3–7, 16, 17]. These swaps have primarily been composed of 2– 3 or more simultaneous exchanges (loops), and non-simultaneous chains driven by non-directed donors.…”

Section: Discussionmentioning

confidence: 99%

“…A number of additional advances have now made the clinical practice of exchanging kidneys between patients in different transplant centers commonplace. The major pieces that needed to be tested and validated were the successful outcomes obtained when unrelated donors and recipients exchange kidneys, and the ability to safely preserve and ship living donor kidneys over distances sufficient to permit exchanges between multiple geographic regions [3–7]. The National Kidney Registry (NKR) is a voluntary network of 83 transplant centers in 32 States in the United States (US), focused on the timely transplantation of live donor kidneys through novel computational algorithms that facilitate exchanges of kidneys between member centers.…”

Section: Introductionmentioning

confidence: 99%

“…The primary indications for KPD are ABO incompatibility (ABOi) and/or lymphocytotoxic crossmatch reactivity [3–7]. In addition, a smaller but growing number of patients are compatible pairs who are seeking anatomic, physiologic, or immunologic advantage from a paired exchange [9].…”

Section: Introductionmentioning

confidence: 99%

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The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries

Flechner

Thomas

Ronin

et al. 2018

American Journal of Transplantation

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The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR. Compared with all United Network for Organ Sharing (UNOS) live donor transplant patients (49 610), all UNOS living unrelated transplant patients (23 319), and all other KPD transplant patients (4236), the demographic and clinical characteristics of NKR transplant patients (2037) appear similar to contemporary national trends. In particular, among the NKR patients, there were a significantly (P < .001) greater number of retransplants (25.6% vs 11.5%), hyperimmunized recipients (22.7% vs 4.3% were cPRA >80%), female recipients (45.9% vs 37.6%), black recipients (18.2% vs 13%), and those on public insurance (49.7% vs 41.8%) compared with controls. These results support the need for greater sharing and larger pool sizes, perhaps enhanced by the entry of compatible pairs and even chains initiated by deceased donors, to unlock more opportunities for those harder-to-match pairs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries

Flechner

Thomas

Ronin

et al. 2018

American Journal of Transplantation

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“…5,6 Secondly, the advent of living-donor pairedexchange programs (LDPE) has helped to both increase living donor numbers and provide kidneys for recipients who are highly sensitized. 7,8 Along with the LDPE, incorporation of non-directed altruistic donors has also helped improve donor numbers by initiating several LDPE chains. 7,8 A final way to increase the living donor pool is to use marginal-living donors.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Along with the LDPE, incorporation of non-directed altruistic donors has also helped improve donor numbers by initiating several LDPE chains. 7,8 A final way to increase the living donor pool is to use marginal-living donors. Although there is no established definition of a marginal-living donor, these donors can include elderly, obese, or donors with renal anomalies that would typically exclude them from kidney donation.…”

Section: Introductionmentioning

confidence: 99%

Expanding living kidney donor criteria with ex-vivo surgery for renal anomalies

McGregor

Rampersad

Patel

2016

CUAJ

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Introduction: Renal transplantation remains the gold standard treatment for end-stage renal disease, with living donor kidneys providing the best outcomes in terms of allograft survival. As the number of patients on the waitlist continues to grow, solutions to expand the donor pool are ongoing. A paradigm shift in the eligibility of donors with renal anomalies has been looked at as a potential source to expand the living donor pool. We sought to determine how many patients presented with anatomic renal anomalies at our transplant centre and describe the ex-vivo surgical techniques used to render these kidneys suitable for transplantation. Methods: A retrospective review was performed of all patients referred for surgical suitability to undergo laparoscopic donor nephrectomy between January 2011 and January 2015. Patient charts were analyzed for demographic information, perioperative variables, urological histories, and postoperative outcomes. Results: 96 referrals were identified, of which 81 patients underwent laparoscopic donor nephrectomy. Of these patients, 11 (13.6%) were identified as having a renal anomaly that could potentially exclude them from the donation process. These anomalies included five patients with unilateral nephrolithiasis, four patients with large renal cysts (>4 cm diameter), one patient with an angiomyolipoma (AML) and one patient with a calyceal diverticulum filled with stones. A description of the ex-vivo surgical techniques used to correct these renal anomalies is provided. Conclusions:We have shown here that ex-vivo surgical techniques can safely and effectively help correct some of these renal anomalies to render these kidneys transplantable, helping to expand the living donor pool.

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