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

Abstract

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.