Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation

被引:139
作者
Montgomery, RA
Zachary, AA
Ratner, LE
Segev, DL
Hiller, JM
Houp, J
Cooper, M
Kavoussi, L
Jarrett, T
Burdick, J
Maley, WR
Melancon, JK
Kozlowski, T
Simpkins, CE
Phillips, M
Desai, A
Collins, V
Reeb, B
Kraus, E
Rabb, H
Leffell, MS
Warren, DS
机构
[1] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Sch Med, Dept Urol, Baltimore, MD 21205 USA
[4] Columbia Univ, Dept Surg, New York, NY 10027 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2005年 / 294卷 / 13期
关键词
D O I
10.1001/jama.294.13.1655
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context First proposed 2 decades ago, live kidney paired donation (KPD) was considered a promising new approach to addressing the shortage of organs for transplantation. Ethical, administrative, and logistical barriers initially proved formidable and prevented the implementation of KPD programs in the United States. Objective To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. Design, Setting, and Patients Prospective series of paired donations matched and transplanted from a pool of blood type or crossmatch incompatible donors and recipients with end-stage renal disease (6 conventional and 4 unconventional KPD transplants) at a US tertiary referral center (between June 2001 and November 2004) with expertise in performing transplants in patients with high immunologic risk. Intervention Kidney paired donation and live donor renal transplantation. Main Outcome Measures Patient survival, graft survival, serum creatinine levels, rejection episodes. Results A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up of 13 months (range, 1-42 months), the patient survival rate was 100% and the graft survival rate was 95.5%. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8 mg/dl) (106.1 mu mol/L [range, 70.7-159.1 mu mol/L]). 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%). Conclusions This series of patients who received transplants from a single-center KPD pool provides evidence that recipients with incompatible live donors, even those with rare blood type combinations or high degrees of HLA antigen sensitization, can receive transplants through KPD with graft survival rates that appear to be equivalent to directed, compatible live donor transplants, if these results can be generalized, broader availability of KPD to the estimated 6000 patients with incompatible donors could result in a large expansion of the donor pool.
引用
收藏
页码:1655 / 1663
页数:9
相关论文
共 29 条
[1]   Increased rejection in living unrelated versus living related kidney transplants does not affect short-term function and survival [J].
Fuller, TF ;
Feng, S ;
Brennan, TV ;
Tomlanovich, S ;
Bostrom, A ;
Freise, CE .
TRANSPLANTATION, 2004, 78 (07) :1030-1035
[2]   A comparison of populations served by kidney paired donation and list paired donation [J].
Gentry, SE ;
Segev, DL ;
Montgomery, RA .
AMERICAN JOURNAL OF TRANSPLANTATION, 2005, 5 (08) :1914-1921
[3]   ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. [J].
Gloor, JM ;
Lager, DJ ;
Moore, SB ;
Pineda, AA ;
Fidler, ME ;
Larson, TS ;
Grande, JP ;
Schwab, TR ;
Griffin, MD ;
Prieto, M ;
Nyberg, SL ;
Velosa, JA ;
Textor, SC ;
Platt, JL ;
Stegall, MD .
TRANSPLANTATION, 2003, 75 (07) :971-977
[4]   Desensitization and subsequent transplantation kidney transplantation of patient using intravenous immunoglobulins (IVIg) [J].
Glotz, D ;
Antoine, C ;
Julia, P ;
Suberbielle-Boissel, C ;
Boudjeltia, S ;
Fraoui, R ;
Hacen, C ;
Duboust, A ;
Bariety, J .
AMERICAN JOURNAL OF TRANSPLANTATION, 2002, 2 (08) :758-760
[5]  
Jordan Stanley C, 2003, Clin Transpl, P193
[6]   HYPERACUTE REJECTION OF KIDNEY ALLOGRAFTS ASSOCIATED WITH PRE-EXISTING HUMORAL ANTIBODIES AGAINST DONOR CELLS [J].
KISSMEYE, F ;
OLSEN, S ;
PETERSEN, VP ;
FJELDBORG, O .
LANCET, 1966, 2 (7465) :662-+
[7]   US surgeons do first "triple-swap" kidney transplantation [J].
McLellan, F .
LANCET, 2003, 362 (9382) :456-456
[8]   Transplanting patients with a positive donor-specific crossmatch: A single center's perspective [J].
Montgomery, RA ;
Zachary, AA .
PEDIATRIC TRANSPLANTATION, 2004, 8 (06) :535-542
[9]   Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients [J].
Montgomery, RA ;
Zachary, AA ;
Racusen, LC ;
Leffell, MS ;
King, KE ;
Burdick, J ;
Maley, WR ;
Ratner, LE .
TRANSPLANTATION, 2000, 70 (06) :887-895
[10]   Exchange donor program in kidney transplantation [J].
Park, K ;
Moon, JI ;
Kim, SI ;
Kim, YS .
TRANSPLANTATION, 1999, 67 (02) :336-338