SP66377 KIDNEY EXCHANGE TRANSPLANTS IN 2015 AT ONE TRANSPLANTCENTER IN INDIA: A MODEL FORTHE DEVELOPING WORLD TO PREVENT COMMERCIAL TRANSPLANTATION

Abstract

Introduction and Aims: Because access to transplantation with desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney exchange transplantation promises hope to a growing number of end-stage renal disease (ESRD) patient in India. Method(s): We present a government and institutional ethical review board approved study of 77 ESRD patients [25 two-way and 7 three-way pairs and one domino chain of 6 pairs] who consented to participate in kidney exchange transplantation at our single center from 1 January 2015 to 1 January 2016. We have performed total 380 KT from 1 January 2015 to 1 January 2016 (71 deceased donor, 309 living donor). Kidney exchange constitutes 24.9 % of living donor kidney transplant (LDKT) in 2015. We have performed first non-simultaneous domino chain transplant of 6 ESRD patients and 6 donors in single center in august 2015. We have performed first international kidney exchange Transplant on 17 February 2015. Result(s): The reason for joining kidney exchange transplantation was blood group incompatibility (n = 45) or positive donor specific antibody/lymphocyte cross-match (n =26) and for better HLA matching (n=6). All patients had anatomic, functional, and immunologically comparable donors. The waiting time in KPD was short as compared to deceased donor KT. Laparoscopic donor nephrectomy was performed in 77 donors. Recipients underwent open (n=52), robotic ((n=24) and laparoscopic KT. Donor relationships were spousal (n = 48), parental (n = 24), mother in law (n=3), grandmother (n=1) and aunt (n =1). Graft survival was 100%. Two patients died with functioning graft due to ischemic heart disease (n=1) and pneumonia (n=1). 14.2% (n=11) had biopsy-proven acute rejection and responded to standard antirejection therapy. Mean serum creatinine was 1.2 mg/dl. Figure 1 and 2 showing growth of kidney exchange transplantation in our center Conclusion(s): KPD is a viable, legal, and rapidly growing modality for facilitating LDKT for patients who are incompatible with their healthy, willing living donor. To the best of our knowledge this is largest number of kidney exchange transplantations in single center in one year in the World. It should be promoted to overcome the organ crisis and shortage of DDKT program. (Figure presented).