Outcomes of Paired-Exchange Live-Donor Kidney Transplantation: A Single-Center Experience A. Bhargava, S. Arora, R.J. Marcus, and K.K. Sureshkumar* Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
ABSTRACT Introduction. Paired-exchange kidney transplantation (PEKT) enables recipients with willing but incompatible donors to find potential matches from a larger pool of donors. It involves transportation of donor kidneys to the intended recipient with a consequent increase in the cold ischemia time (CIT). Patients and Methods. Our single-center study compared the outcomes of PEKT versus traditional in-center live-donor kidney transplants (ICKT). Retrospective chart review of adult patients who underwent PEKT and ICKT from January 2009 to February 2012 at our institution was performed. Delayed graft function, acute rejection rates, incidence of proteinuria, trends in serum creatinine, and graft and patient survival rates were compared between groups. Results. Baseline demographic data were similar between the PEKT group (n ¼ 15) and the ICKT group (n ¼ 30) except that CIT (13.1 vs 3.8 hours; P < .001) and panel reactive antibody titers (12.6% 22.9% vs 0.9% 4.9%; P ¼ .01) were significantly higher in the PEKT group. No patient developed delayed graft function. At a median follow-up of 12.4 months (range: 2e27.5 months), graft and patient survival rates were 100% in both groups. Serial creatinine levels were similar between the groups. There were no significant differences between groups in acute rejection rates (3 of 15 vs 3 of 30) and development of proteinuria posttransplantation (8 of 15 vs 22 of 30). Conclusions. Our study found similar outcomes between the PEKT and ICKT groups despite longer CIT and higher panel reactive antibody titers in the PEKT group. These findings support the current practice of PEKT with transporting of donor kidneys, with the resultant increase in the chances of living-donor kidney transplantation.
L
IVING-DONOR kidney transplantation offers improved graft survival with fewer posttransplant complications compared with transplantation of deceased-donor kidneys. ABO incompatibility and positive cross-match are barriers to traditional living-donor transplantation in roughly one third of instances. Pairedexchange kidney transplantation (PEKT) is one method of expanding the donor pool. PEKT enables a recipient with a willing but incompatible donor to find a potential match from a larger pool of donors. Recent practices involve transporting the kidney rather than making the donor travel. Our study aimed to compare the outcomes of PEKT versus traditional in-center kidney transplantation (ICKT) in a single center.
PATIENTS AND METHODS The study protocol was approved by our institutional review board. Using the transplant database at our institution, we identified patients >18 years old who received either PEKT or ICKT from January 2009 to February 2012. Patients received induction with rabbit antithymocyte globulin, alemtuzumab, or basiliximab and
This research was presented as a poster at the National Kidney Foundation Spring Clinical Meeting, April 2-6, 2013, Lake Buena Vista, FL. *Address correspondence to Kalathil K. Sureshkumar, MD, FRCP (Glasg), FASN, Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212. E-mail: [email protected]
0041-1345/14 http://dx.doi.org/10.1016/j.transproceed.2014.06.070
ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
3420
Transplantation Proceedings, 46, 3420e3422 (2014)
PAIRED-EXCHANGE LIVE-DONOR KIDNEY TRANSPLANTATION Table 1. Patients’ Demographic Characteristics Parameter
PEKT (n ¼ 15)
ICKT (n ¼ 30)
P Value
Donor age, y Donor sex (male/female) Donor BMI, kg/m2 Donor serum creatinine Recipient age, y Recipient sex (male/female) Recipient BMI, kg/m2 Pretransplant dialysis, mo Recipient hypertension Recipient diabetes Preemptive transplant Previous transplant Panel reactive antibodies, % HLA mismatches Cold ischemia time, h Delayed graft function
46.2 13.2 53/47 27.7 6.6 0.77 0.21 51.3 15.5 66/34 29.0 5.2 23.2 15.2 15 of 15 9 of 15 5 of 15 3 of 15 12.6 22.9 4.0 2.1 13.1 6.6 0
43.3 12.0 40/60 26.7 4.0 1.38 1.9 51.9 9.9 64/36 29.2 4.8 17.3 14.4 28 of 30 10 of 30 11 of 30 2 of 30 0.9 4.9 4.7 1.8 3.8 2.6 0
.47 .01 .65 .30 .88 .83 .90 .32 .31 .08 .83 .18 .01 .31 20 hours was associated with reduced 1- and 5-year graft survival rates, an effect that was more dramatic when the donors were
ABSTRACT Introduction. Paired-exchange kidney transplantation (PEKT) enables recipients with willing but incompatible donors to find potential matches from a larger pool of donors. It involves transportation of donor kidneys to the intended recipient with a consequent increase in the cold ischemia time (CIT). Patients and Methods. Our single-center study compared the outcomes of PEKT versus traditional in-center live-donor kidney transplants (ICKT). Retrospective chart review of adult patients who underwent PEKT and ICKT from January 2009 to February 2012 at our institution was performed. Delayed graft function, acute rejection rates, incidence of proteinuria, trends in serum creatinine, and graft and patient survival rates were compared between groups. Results. Baseline demographic data were similar between the PEKT group (n ¼ 15) and the ICKT group (n ¼ 30) except that CIT (13.1 vs 3.8 hours; P < .001) and panel reactive antibody titers (12.6% 22.9% vs 0.9% 4.9%; P ¼ .01) were significantly higher in the PEKT group. No patient developed delayed graft function. At a median follow-up of 12.4 months (range: 2e27.5 months), graft and patient survival rates were 100% in both groups. Serial creatinine levels were similar between the groups. There were no significant differences between groups in acute rejection rates (3 of 15 vs 3 of 30) and development of proteinuria posttransplantation (8 of 15 vs 22 of 30). Conclusions. Our study found similar outcomes between the PEKT and ICKT groups despite longer CIT and higher panel reactive antibody titers in the PEKT group. These findings support the current practice of PEKT with transporting of donor kidneys, with the resultant increase in the chances of living-donor kidney transplantation.
L
IVING-DONOR kidney transplantation offers improved graft survival with fewer posttransplant complications compared with transplantation of deceased-donor kidneys. ABO incompatibility and positive cross-match are barriers to traditional living-donor transplantation in roughly one third of instances. Pairedexchange kidney transplantation (PEKT) is one method of expanding the donor pool. PEKT enables a recipient with a willing but incompatible donor to find a potential match from a larger pool of donors. Recent practices involve transporting the kidney rather than making the donor travel. Our study aimed to compare the outcomes of PEKT versus traditional in-center kidney transplantation (ICKT) in a single center.
PATIENTS AND METHODS The study protocol was approved by our institutional review board. Using the transplant database at our institution, we identified patients >18 years old who received either PEKT or ICKT from January 2009 to February 2012. Patients received induction with rabbit antithymocyte globulin, alemtuzumab, or basiliximab and
This research was presented as a poster at the National Kidney Foundation Spring Clinical Meeting, April 2-6, 2013, Lake Buena Vista, FL. *Address correspondence to Kalathil K. Sureshkumar, MD, FRCP (Glasg), FASN, Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212. E-mail: [email protected]
0041-1345/14 http://dx.doi.org/10.1016/j.transproceed.2014.06.070
ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
3420
Transplantation Proceedings, 46, 3420e3422 (2014)
PAIRED-EXCHANGE LIVE-DONOR KIDNEY TRANSPLANTATION Table 1. Patients’ Demographic Characteristics Parameter
PEKT (n ¼ 15)
ICKT (n ¼ 30)
P Value
Donor age, y Donor sex (male/female) Donor BMI, kg/m2 Donor serum creatinine Recipient age, y Recipient sex (male/female) Recipient BMI, kg/m2 Pretransplant dialysis, mo Recipient hypertension Recipient diabetes Preemptive transplant Previous transplant Panel reactive antibodies, % HLA mismatches Cold ischemia time, h Delayed graft function
46.2 13.2 53/47 27.7 6.6 0.77 0.21 51.3 15.5 66/34 29.0 5.2 23.2 15.2 15 of 15 9 of 15 5 of 15 3 of 15 12.6 22.9 4.0 2.1 13.1 6.6 0
43.3 12.0 40/60 26.7 4.0 1.38 1.9 51.9 9.9 64/36 29.2 4.8 17.3 14.4 28 of 30 10 of 30 11 of 30 2 of 30 0.9 4.9 4.7 1.8 3.8 2.6 0
.47 .01 .65 .30 .88 .83 .90 .32 .31 .08 .83 .18 .01 .31 20 hours was associated with reduced 1- and 5-year graft survival rates, an effect that was more dramatic when the donors were
