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In a living donor kidney transplantation (LDKT) dominated transplant program, kidney exchange may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages.
Here, we report our experience of 500 single-centre kidney paired donation ( KPD) transplantation to increase LDKT in India.
Between January 2000 and August 2023,5236 LDKT and 1252 DDKT were performed at our transplantation centre, 500 (9.54%) using KPD. 397 male, 103 female recipients, and 389 female and 111 male donors. The reasons for joining KPD in transplanted patients were ABO incompatibility (n = 360), sensitization (n = 92), and better HLA/age matching (n = 48). All donors were near relatives [wife (n=268), husband (n=66), mother (n=103), father (n=31), sister (n=14), brother (n=9) and others (n=9)]. There were 186 two-way (n =372, 27 three-way (n = 81), 5 four-way (n = 20), 1 five-way (n=5), 2 six-way (n = 12) and one ten-way kidney exchange (n = 10). The graft survival, patient survival, biopsy-proven rejection rate, and graft function was similar to other LDKT outcomes. We credit the success of our kidney exchange program to maintaining a registry of incompatible pairs, counselling on kidney exchange, a high-volume LDKT program, and teamwork.
This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programs do not exist. We report largest number of KPD transplants in Asia in single centre.
Part of this abstract has been presented prior at ISOT 2023, Kolkata, India.