Paired kidney exchange transplantation: Maximizing the donor pool.
Paired kidney exchange transplantation: Maximizing the donor pool.
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DOI：
10.4103/0971-4065.150721
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发表时间：
2015-11-01
影响因子：
0.8
通讯作者：
Kher, V
中科院分区：
文献类型：
--
作者：
Jha, P K;Sethi, S;Kher, V
在过去的十年中，配对肾脏交换（PKE）移植作为终末期肾脏疾病（ESRD）患者不相容或致敏的可行替代方案在全球范围内得到了普及。本研究介绍了PKE移植的经验，并比较了PKE和非PKE肾移植受者的预后。2010年2月至2013年11月，共进行了742例移植，其中26例（3.5%）为PKE移植。都是双向交流。PKE受者明显大于非PKE受者（46.73±9.71∶40.08±13.36;P = 0.012），而供者年龄具有可比性。PKE患者HLA错配数明显高于PKE患者（5.03±1.14∶3.49±1.57;P < 0.0001）。中位随访20个月（范围：3-47个月）后，患者生存率（PKE 96.16% vs非PKE 96.65%, P = 0.596）和死亡审查移植生存率（PKE 96.16% vs非PKE 96.37%, P = 1）无显著差异。PKE组1个月和最后一次随访时的平均血清肌酐低于非PKE组（分别为0.98±0.33∶1.3±0.61 mg/dl, P = 0.008和0.96±0.30∶1.27±0.57 mg/dl, P = 0.006）。活检证实PKE组急性排斥反应发生率为11.5%，非PKE组为16.89% （P = 0.6）。综上所述，配对肾脏捐献是增加供体库的一种极好的方式，需要在我国推广，以克服合适肾脏的短缺。
In the last decade, paired kidney exchange (PKE) transplantation has gained popularity worldwide as a viable alternative for end stage renal disease (ESRD) patients who have incompatible or sensitized donors. This study presents our experience with PKE transplantation and compares outcome between PKE and non-PKE renal transplant recipients. Between February 2010 and November 2013, 742 transplants were performed, of which 26 (3.5%) were PKE transplantations. All were two-way exchanges. PKE recipients were significantly older than non-PKE (46.73 ± 9.71 vs. 40.08 ± 13.36 years; P = 0.012) while donor ages were comparable. PKE patients had significantly higher number of HLA mismatches (5.03 ± 1.14 vs. 3.49 ± 1.57; P < 0.0001). After a median follow-up of 20 months (range: 3-47 months), there was no significant difference in patient survival (PKE 96.16% vs. non-PKE 96.65%; P = 0.596) and death censored graft survival (PKE 96.16% vs. non-PKE 96.37%; P = 1). Mean serum creatinine at 1 month and at last follow-up was lower in PKE versus non-PKE group (0.98 ± 0.33 vs. 1.3 ± 0.61 mg/dl; P = 0.008 and 0.96 ± 0.30 vs. 1.27 ± 0.57 mg/dl, P = 0.006, respectively). Biopsy proven acute rejection rate was 11.5% in PKE group and 16.89% in non-PKE patients (P = 0.6). To conclude, paired kidney donation is an excellent way of increasing the donor pool and needs to be promoted to overcome the shortage of suitable kidney in our country.