1
|
Kute VB, Fleetwood VA, Chauhan S, Meshram HS, Caliskan Y, Varma C, Yazıcı H, Oto ÖA, Lentine KL. Kidney paired donation in developing countries: A global perspective. CURRENT TRANSPLANTATION REPORTS 2023; 10:117-125. [PMID: 37720696 PMCID: PMC10501157 DOI: 10.1007/s40472-023-00401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Purpose of review We review the key principles of kidney paired donation (KPD) and discuss the status and unique considerations for KPD in developing countries. Recent findings Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices. Summary KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need world-wide.
Collapse
Affiliation(s)
- Vivek B Kute
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Vidya A. Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Chintalapati Varma
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Halil Yazıcı
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Özgür Akın Oto
- Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
2
|
Kute VB, Patel HV, Mishra VV, Agarwal SK. Optimum Chain Length in Kidney Exchange Program and the Way Ahead. Indian J Nephrol 2021; 31:95-96. [PMID: 34267429 PMCID: PMC8240927 DOI: 10.4103/ijn.ijn_376_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/17/2020] [Accepted: 03/08/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Himanshu V. Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vineet V. Mishra
- Department of Nephrology, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Abstract
INTRODUCTION Sensitization to human leukocyte antigens has long posed an obstacle to organ transplantation. With desensitization protocol refinement, new drug development, and organ allocation policy changes, access to transplant for sensitized patients has never been greater. Yet in spite of these advances the problem of donor-specific antibody remains incompletely solved, and many patients remain poorly served by the therapies that do exist. Area covered: Imlifidase is a new drug with a mechanism of action that enables it to transiently yet efficiently eliminate donor-specific antibody over a much more rapid time course than any heretofore existing therapy. This unique property suggests that imlifidase may have far-reaching potential for patients in whom donor-specific antibodies may preclude successful transplantation. Below follows a review of the clinical experience with imlifidase to date as well as a discussion of the transplant applications that eagerly await the availability of this novel agent. Expert opinion: Imlifidase is a first-in-class pharmaceutical agent that safely and efficiently cleaves IgG, and holds promise to be a game-changer for sensitized patients in need of lifesaving organ transplants.
Collapse
Affiliation(s)
- Bonnie E Lonze
- Vice Chair for Research, NYU Langone Health, Transplant Institute , New York, NY, USA
| |
Collapse
|
4
|
Manook M, Johnson R, Robb M, Burnapp L, Fuggle SV, Mamode N. Changing patterns of clinical decision making: are falling numbers of antibody incompatible transplants related to the increasing success of the UK Living Kidney Sharing Scheme? A national cohort study. Transpl Int 2020; 34:153-162. [PMID: 33095917 DOI: 10.1111/tri.13776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/03/2019] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
Abstract
Antibody incompatibility is a barrier to living kidney transplantation; antibody incompatible transplantation (AIT) is an accepted treatment modality, albeit higher risk. This study aims to determine changes to clinical decision making and access to AIT in the UK. An electronic survey was sent to all UK renal transplant centres (n = 24), in 2014, and again in 2018. Questions focused on entry & duration in the UKLKSS for HLA and ABO-incompatible pairs, Can and provision of direct AIT transplantation within those centres. Between 2014 & 2018, the duration recommended for patients in the UKLKSS increased. In 2014, 34.8% of centres reported leaving HLA-i pairs in the UKLKSS indefinitely, or reviewing on a case by case basis, by 2018 this increased to 61%. Centres offering direct HLA-i transplantation reduced from 58% to 37%. For low titre (1:8) ABO-i recipients, 66% of centres recommended at least 9 months (3 matching runs) in the UKLKSS scheme in 2018, compared to 47% in 2014, 50% fewer units consider direct ABO-i transplantation for unsuccessful pairs with high ABO titres (>1:512). Over time, clinicians appear to be facilitating more conservative management of AIT patients, potentially limiting access to living donor transplantation.
Collapse
Affiliation(s)
- Miriam Manook
- Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Johnson
- National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Matthew Robb
- National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Lisa Burnapp
- National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Susan V Fuggle
- National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Nizam Mamode
- Renal and Transplant Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Massie AB, Orandi BJ, Waldram MM, Luo X, Nguyen AQ, Montgomery RA, Lentine KL, Segev DL. Impact of ABO-Incompatible Living Donor Kidney Transplantation on Patient Survival. Am J Kidney Dis 2020; 76:616-623. [PMID: 32668318 DOI: 10.1053/j.ajkd.2020.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/15/2020] [Indexed: 12/17/2022]
Abstract
RATIONALE & OBJECTIVE Compared with recipients of blood group ABO-compatible (ABOc) living donor kidney transplants (LDKTs), recipients of ABO-incompatible (ABOi) LDKTs have higher risk for graft loss, particularly in the first few weeks after transplantation. However, the decision to proceed with ABOi LDKT should be based on a comparison of the alternative: waiting for future ABOc LDKTs (eg, through kidney paired exchange) or for a deceased donor kidney transplant (DDKT). We sought to evaluate the patient survival difference between ABOi LDKTs and waiting for an ABOc LDKT or an ABOc DDKT. STUDY DESIGN Retrospective cohort study of adults in the Scientific Registry of Transplant Recipients. SETTING & PARTICIPANTS 808 ABOi LDKT recipients and 2,423 matched controls from among 245,158 adult first-time kidney-only waitlist registrants who did not receive an ABOi LDKT and who remained on the waitlist or received either an ABOc LDKT or an ABOc DDKT, 2002 to 2017. EXPOSURE Receipt of ABOi LDKT. OUTCOME Death. ANALYTICAL APPROACH We compared mortality among ABOi LDKT recipients versus a weighted matched comparison population using Cox proportional hazards regression and Cox models that accommodated for changing hazard ratios over time. RESULTS Compared with matched controls, ABOi LDKT was associated with greater mortality risk in the first 30 days posttransplantation (cumulative survival of 99.0% vs 99.6%) but lower mortality risk beyond 180 days posttransplantation. Patients who received an ABOi LDKT had higher cumulative survival at 5 and 10 years (90.0% and 75.4%, respectively) than similar patients who remained on the waitlist or received an ABOc LDKT or ABOc DDKT (81.9% and 68.4%, respectively). LIMITATIONS No measurement of ABO antibody titers in recipients; eligibility of participants for kidney paired donation is unknown. CONCLUSIONS Transplant candidates who receive an ABOi LDKT and survive more than 180 days posttransplantation experience a long-term survival benefit compared to remaining on the waitlist to potentially receive an ABOc kidney transplant.
Collapse
Affiliation(s)
- Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Babak J Orandi
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anh Q Nguyen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A Montgomery
- NYU Langone Medical Center, New York University School of Medicine, New York, NY
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; Scientific Registry for Transplant Recipients, Minneapolis, MN.
| |
Collapse
|
6
|
Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-Paired Donation to Increase Living Donor Kidney Transplantation in India: Guidelines of Indian Society of Organ Transplantation - 2017. Indian J Nephrol 2018. [PMID: 29515294 PMCID: PMC5830802 DOI: 10.4103/ijn.ijn_365_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Vivek B Kute
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanjay K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, Artemis Hospital, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Anant Kumar
- Department of Transplantation Surgery, Max Group of Hospital, New Delhi, India
| | - Manish Rathi
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajkumar K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishan L Gupta
- Department of Nephrology, The Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Shroff
- Department of Transplantation Surgery, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Sandip K Saxena
- Department of Nephrology, Apollo Hospital, Indore, Madhya Pradesh, India
| | - Pankaj R Shah
- Department of Nephrology, Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Pranjal R Modi
- Department of Transplantation Surgery Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vishwanath Billa
- Department of Nephrology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | | | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dhamedndra S Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tarun K Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | | | - Amresh Krishna
- Department of Nephrology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Rajshekhar Perumalla
- Department of Transplantation Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India
| | - Manoj Jain
- Department of Renal Pathology Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Guleria
- Department of Transplantation Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael A Rees
- Department of Transplantation Surgery, University of Toledo Medical Center, Toledo, Ohio.,CEO, Alliance for Paired Donation, USA
| |
Collapse
|