Kidney paired donation: principles, protocols and programs

Due to the ongoing shortage of deceased-donor organs, novel strategies to augment kidney transplantation rates through expanded living donation strategies have become essential. These include desensitization in antibody-incompatible transplants and kidney paired donation (KPD) programs. KPD enables...

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Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2015-08, Vol.30 (8), p.1276-1285
Main Authors: Ferrari, Paolo, Weimar, Willem, Johnson, Rachel J, Lim, Wai H, Tinckam, Kathryn J
Format: Article
Language:English
Subjects:
Algorithms
Decision Support Techniques
Donor Selection - organization & administration
Histocompatibility
Humans
Kidney Transplantation
Living Donors - supply & distribution
Nephrectomy
Program Development
Registries
Tissue and Organ Procurement - organization & administration
Tissue Donors
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Summary:Due to the ongoing shortage of deceased-donor organs, novel strategies to augment kidney transplantation rates through expanded living donation strategies have become essential. These include desensitization in antibody-incompatible transplants and kidney paired donation (KPD) programs. KPD enables kidney transplant candidates with willing but incompatible living donors to join a registry of other incompatible pairs in order to find potentially compatible transplant solutions. Given the significant immunologic barriers with fewer donor options, single-center or small KPD programs may be less successful in transplanting the more sensitized patients; the optimal solution for the difficult-to-match patient is access to more potential donors and large multicenter or national registries are essential. Multicenter KPD programs have become common in the last decade, and now represent one of the most promising opportunities to improve transplant rates. To maximize donor-recipient matching, and minimize immunologic risk, these multicenter KPD programs use sophisticated algorithms to identify optimal match potential, with simultaneous two-, three- or more complex multiway exchanges. The article focuses on the recent progresses in KPD and it also reviews some of the differences and commonalities across four different national KPD programs.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfu309