Kute VB1, Patel HV1, Shah PR1, Shah PS1, Vanikar AV2, Modi PR3, Shah VR4, Rizvi SJ3, Pal BC3, Varyani UT1, Wakhare PS1, Shinde SG1, Godhela VA1, MK Shah1, Gattani VS1, Shah JH1, Wadhai KG1, Kasat GS1, Patil MV1, Patel JC1, Kumar DP1, Trivedi VB1, Patel MH2, Trivedi HL1

Departments and Institution

 1. Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences [IKDRC-ITS], Ahmedabad, India.

2. Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, IKDRC-ITS, Ahmedabad, India.

3. Department of Urology and transplantation, IKDRC-ITS, Ahmedabad, India.

4. Department of Anesthesia, IKDRC-ITS, Ahmedabad, India.

Corresponding Author

 Dr. Vivek Kute

MBBS, MD, FCPS, DM Nephrology (Gold Medalist), FASN

Associate Professor, Faculty of Nephrology and Transplantation

Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, (IKDRC-ITS) Ahmedabad, India. (M): +919099927543, (E): [email protected]

Conflict of interest: None

Abstract:

Introduction: India is having mainly living donor kidney transplantation (LDKT) program (90%). Desensitization protocols, ABO incompatible kidney transplantation (KT), deceased donor kidney transplant(DDKT) could not be expanded. Kidney paired donation (KPD) promises hope to ESRD patients because of best outcome.

Methods: Prospective single center observation study of 77 KPD transplantation [25 two-way, 7 three-way exchanges and one domino chain of 6 pairs] in 2015. We have performed 380 KT in 2015 (71 DDKT, 309 LDKT). Reason for joining KPD was ABO incompatibility (n=45), sensitization (n=26) and improving HLA matching (n=6).

Results: 158 pairs were registered and 77 transplants were completed. 13.2% (n=21) are waiting for authorization committee permission despite having KPD donor. We facilitated KPD transplant in 65.3% and 51.3% were completed. Waiting time in KPD was short as compared to DDKT. Graft and patient survival were 100%, 97.4%. 14.2% (n=11) had acute rejection. Transplant match rate among sensitized (n=60) and O group patients (n=62) was 58.3% (n=35), 41.9% (n=26) of which 43.3% (n=26), 29% (n=18) KT were completed and 15% (n=9), 12.9% (n=8) waiting for authorization committee permission. Key to success is formation of registry to maintain database about ABO incompatible/sensitized patients, awareness/mandatory counseling about KPD, expert transplant coordinator, dedicated team. Figure 1 showed growth of KPD transplantation. Figure 2 showed the milestone of our single center KPD transplantation.

Conclusion: Our single center KPD has increased the LDKT rate by 25% in year 2015. If productivity of our KPD program is replicated on a national level, it will increase LDKT to more than 25%. To the best of our knowledge this is the largest number of KPD transplantations in single center in one year in the world. It should be promoted to  overcome the organ crisis and shortage of DDKT program when national program does not exist. This will prevent the commercial KT.