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A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges. At a median follow-up of 13 months, the patient survival rate was 100 percent and the graft survival rate was 95.5 percent. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL. There were no instances of antibody-mediated rejection despite the inclusion of 5 patients who were highly sensitized to HLA antigens due to previous exposure to foreign tissue. Four patients developed acute cellular rejection (18 percent).

The complexity and potential benefits of an unconventional KPD transplant are demonstrated by the triple exchange. Based on blood type and HLA antigen antibody reactivity, the probability of finding a suitable donor in the deceased donor pool for each of the 3 recipients was 0.029, 0.033 and 0.008.

"This study demonstrates that KPD transplants can be performed with outcomes similar to compatible living donor kidney transplants. The cost savings and decrease in waiting time that could be realized by a wider application of this concept are substantial. Because the likelihood of finding a suitable match is dependent on the size of the pool, a national list could enable many more transplants. We estimate that about half of the incompatible pairs could receive transplants using a national KPD transplant scheme with blood type compatible, negative crossmatch kidneys, including as many as 14 percent of the highly sensitized patients," the authors write.

"Patients unable to be matched by KPD could undergo desensitization with their intended donor. Those who were not deemed ac
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Contact: Eric Vohr
410-955-8665
JAMA and Archives Journals
4-Oct-2005