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kidney paired donation

Lung-Yi Lee, Thomas A Pham, Marc L Melcher
End-stage renal disease (ESRD) is a significant health care burden. Although kidney transplantation is the optimal treatment modality, less than 25% of waiting list patients are transplanted because of organ shortage. Living kidney donation can lead to better recipient and graft survival and increase the number of donors. Not all ESRD patients have potential living donors, and not all living donors are a compatible match to recipients. Kidney paired exchanges allow incompatible pairs to identify compatible living donors for living donor kidney transplants for multiple recipients...
February 2019: Surgical Clinics of North America
Sebastian Przech, Amit X Garg, Jennifer B Arnold, Lianne Barnieh, Meaghan S Cuerden, Christine Dipchand, Liane Feldman, John S Gill, Martin Karpinski, Greg Knoll, Charmaine Lok, Matthew Miller, Mauricio Monroy, Chris Nguan, G V Ramesh Prasad, Sisira Sarma, Jessica M Sontrop, Leroy Storsley, Scott Klarenbach
BACKGROUND: Approximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity. METHODS: To better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey...
December 2018: Journal of the American Society of Nephrology: JASN
Jenny Hc Chen, Peter Hughes, Claudia Woodroffe, Paolo Ferrari
Baseline pre-donation eGFR appears to predict the risk of post-donation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90ml/min/1.73m2 as an acceptable level of GFR for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1-year follow-up linking records in the AKX database and ANZDATA...
October 24, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Lauren Brasile, Nicholas Henry, Giuseppe Orlando, Bart Stubenitsky
BACKGROUND: The potential of a Mesenchymal Stem Cell (MSC) therapy to accelerate the repair of ischemically damaged human kidneys during 24 hours of warm perfusion was evaluated. The hypothesis was that by administering MSC directly to the renal tissue, there would be an improved opportunity for cellular repair mediated by intrarenal paracrine effects. METHODS: Studies were performed using the Exsanguinous Metabolic Support (EMS) tissue-engineering platform. Five pairs of human kidney allografts from donation after cardiac death (DCD) donors were studied...
September 17, 2018: Transplantation
Mathieu Bray, Wen Wang, Peter X-K Song, John D Kalbfleisch
In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD...
April 2018: Statistics in Biosciences
Danielle N Bozek, Ty B Dunn, Christian S Kuhr, Christopher L Marsh, Jeffrey Rogers, Susan E Rees, Laura Basagoitia, Robert J Brunner, Alvin E Roth, Obi Ekwenna, David E Fumo, Kimberly D Krawiec, Jonathan E Kopke, Puneet Sindhwani, Jorge Ortiz, Miguel Tan, Siegfredo R Paloyo, Jeffrey D Punch, Michael A Rees
BACKGROUND: Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens. OBJECTIVE: While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015...
March 2018: European Urology Focus
Courtenay M Holscher, Kyle Jackson, Alvin G Thomas, Christine E Haugen, Sandra R DiBrito, Karina Covarrubias, Sommer E Gentry, Matthew Ronin, Amy D Waterman, Allan B Massie, Jacqueline Garonzik Wang, Dorry L Segev
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%)...
November 2018: American Journal of Transplantation
M Kwapisz, R Kieszek, M Bieniasz, K Jędrzejko, M Nita, K Sułkowska, P Palczewski, M Durlik, L Pączek, A Kwiatkowski
BACKGROUND: Multiple renal artery kidneys still represent a special challenge for surgeons, during both nephrectomy for organ donation and transplantation. Recognition of anatomical conditions with advanced imaging methods is one of the most important elements of the preoperative evaluation process. AIM: The purpose of the current study was to assess if anatomical abnormalities affect the outcomes of living kidney donor transplantation procedures. PATIENTS AND METHODS: A retrospective analysis of 60 living kidney donors and their recipients was performed...
July 2018: Transplantation Proceedings
Aline Adour Yacoubian, Rana Abu Dargham, Raja B Khauli
Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors...
June 20, 2018: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Hyunwoo Lee, Seokhyun Chung, Taesu Cheong, Sang Hwa Song
Kidney exchange programs, which allow a potential living donor whose kidney is incompatible with his or her intended recipient to donate a kidney to another patient in return for a kidney that is compatible for their intended recipient, usually aims to maximize the number of possible kidney exchanges or the total utility of the program. However, the fairness of these exchanges is an issue that has often been ignored. In this paper, as a way to overcome the problems arising in previous studies, we take fairness to be the degree to which individual patient-donor pairs feel satisfied, rather than the extent to which the exchange increases social benefits...
July 14, 2018: International Journal of Environmental Research and Public Health
Sebastiaan Heidt, Frans H J Claas
Highly sensitized patients awaiting a kidney transplant accrue on the transplant waiting list. The breadth of HLA antibodies in this subpopulation of patients precludes receiving a compatible organ offer through regular allocation within an acceptable time-frame. Areas covered: Several alternative options to receive a transplant exist for these patients, including additional priority in regular allocation, special programs based on allocation through acceptable antigens, kidney paired donation programs, desensitization protocols, or a combination of the latter two...
August 2018: Expert Review of Clinical Immunology
Vivek B Kute, Narayan Prasad, Pankaj R Shah, Pranjal R Modi
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n -way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange...
June 28, 2018: World Journal of Transplantation
Robert A Montgomery, Vasishta S Tatapudi, Mary S Leffell, Andrea A Zachary
The human major histocompatibility complex is a family of genes that encodes HLAs, which have a crucial role in defence against foreign pathogens and immune surveillance of tumours. In the context of transplantation, HLA molecules are polymorphic antigens that comprise an immunodominant alloreactive trigger for the immune response, resulting in rejection. Remarkable advances in knowledge and technology in the field of immunogenetics have considerably enhanced the safety of transplantation. However, access to transplantation among individuals who have become sensitized as a result of previous exposure to alloantigens is reduced proportional to the breadth of their sensitization...
September 2018: Nature Reviews. Nephrology
L S Baines, H Dulku, R M Jindal, V Papalois
INTRODUCTION: Despite excellent outcomes of kidney paired donation (KPD), little is known about how a patient's frame (apply cognitive bias) or weight (attribute value) and concerns relating to risk, justice, and equity affect his or her decision-making process. MATERIALS AND METHODS: A pilot study consisting of 3 KPD transplant recipients and 3 KPD kidney donors in the last year was conducted to identify and explore themes in decision making and risk taking. The pilot study was followed by the main study comprised of 20 recipients who had already undergone KPD transplantation and 20 donors who had undergone donor nephrectomy...
June 2018: Transplantation Proceedings
Evelyn M Tenenbaum
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors...
March 2018: American Journal of Law & Medicine
Christoph Troppmann, Chandrasekar Santhanakrishnan, Ghaneh Fananapazir, Kathrin Troppmann, Richard Perez
En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P = .006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P = ...
November 2018: American Journal of Transplantation
I Godinho, J Guerra, M J Melo, M Neves, J Gonçalves, M A Santana, A Gomes da Costa
BACKGROUND: With the rising prevalence of living-donor kidney transplantation, evaluation of factors correlated with renal function in the donor-recipient pair constitutes a main goal for kidney transplantation clinicians. Our objective was to analyze the more relevant donor characteristics that contribute to donor and recipient estimated glomerular filtration rates (eGFR) after 1 year. METHODS: We evaluated 48 consecutive donor-recipient pairs from our unit. RESULTS: Mean donor age was 46 ± 11 years, with 71% being women...
April 2018: Transplantation Proceedings
Stuart M Flechner, Alvin G Thomas, Matthew Ronin, Jeffrey L Veale, David B Leeser, Sandip Kapur, John D Peipert, Dorry L Segev, Macey L Henderson, Ashton A Shaffer, Matthew Cooper, Garet Hil, Amy D Waterman
The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR...
November 2018: American Journal of Transplantation
Thomas McGregor, Alp Sener, Steven Paraskevas, Brian Reikie
Kidney paired donation (KPD) programs are an effort to bridge the disparity between kidney supply and demand. These programs combine several incompatible donor-recipient pairs in a national paired exchange database, thereby increasing the number of compatible matches. But KPD programs face unique challenges, particularly the large distances that often separate donors and recipients. Here we discuss key factors to consider when transitioning from a donor travelling model to a kidney shipment model in the Canadian context...
April 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Steven Habbous, Jennifer Arnold, Mehmet A Begen, Neil Boudville, Matthew Cooper, Christine Dipchand, Stephanie N Dixon, Liane S Feldman, Dariusz Goździk, Martin Karpinski, Scott Klarenbach, Greg A Knoll, Ngan N Lam, Krista L Lentine, Charmaine Lok, Eric McArthur, Susan McKenzie, Matthew Miller, Mauricio Monroy-Cuadros, Chris Nguan, G V Ramesh Prasad, Sebastian Przech, Sisira Sarma, Dorry L Segev, Leroy Storsley, Amit X Garg
BACKGROUND: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. STUDY DESIGN: 1 prospective and 1 retrospective cohort study. SETTING & PARTICIPANTS: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times...
March 24, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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