Living donor kidney paired exchange: An observational study
Pukar Chandra Shrestha, Tika Ram Bhandari, Rojan Adhikari, Hari Prasad Baral, Rakesh Kumar Verma, Kalpana Kumari Shrestha
Abstract
Background: Kidney transplantation is the treatment of choice for patients with end-stage renal disease (ESKD). Kidney paired donation (KPD) provides the chance to match an incompatible donor/recipient pair with another donor and recipient in a similar condition. We aimed to compare the outcomes of pair exchange kidney transplantation with traditional live donor kidney transplantation in our context. Method: A review of medical records of 62 patients (31 pairs) who underwent two-way conventional living kidney pair exchange from July 2016 to June 2021 was done. The control group was considered those 62 patients who had undergone classic live donor kidney transplantation (LDKT) during the study period. The patient's demographics, intraoperative and postoperative variables including delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates were compared between the groups (KPD and LDKT). Results: The majority of recipients were male (77.4 and 80.6%) while donors were female (77.4 and 69.4%) in KPD and the LDKT groups. Mean ages were 37 years (range: 19–59) and 37 years (range: 17–65) for the recipient's in KPD and the LDKT. KPD transplantation was performed in 62 recipients to avoid blood group incompatibility. There were no significant differences in outcomes comprising delayed graft function (1.6 and 3.2%), graft survival (100% in both groups), patient survival (95.2 and 96.8%), and rejections rates (1.6 and 1.6%) between KPD and LDKT group (P > 0.005). The length of stay was similar (5.9 and 5.7 days) in KPD and LDKT groups (P > 0.005). Conclusions: The outcomes of KPD were comparable with classic LDKT in terms of delayed graft function, length of hospital stay, graft survival, patient survival, and rejections rates in our study. Therefore, the kidney paired donation program should be encouraged and promoted in centers where the ABO-incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low. HIGHLIGHTS Kidney paired donation (KPD) provides the chance to match for an incompatible donor/recipient pair with another donor and recipient in a similar condition. The outcomes of KPD were comparable with classic live donor kidney transplantation (LDKT) in this study. KPD program should be promoted in centers where the ABO incompatible transplant is expensive with added risk and the rate of deceased donor transplantation is very low. Statistical software SPSS version 25.0 (Statistical Package for the Social Sciences) was used for statistical analysis.Independent t-test test was considered for all quantitative variables while the Chi-square test was applied for all categorical variables during the data analysis. A P value < 0.005 was considered statistically significant.