Korean J Transplant.  2022 Nov;36(Supple 1):S146. 10.4285/ATW2022.F-2649.

Outcomes of paired kidney exchange: an early experience from Nepal

• Kafle, MP
• Singh D

• KMID: 2535662
• DOI: http://doi.org/10.4285/ATW2022.F-2649

Abstract

Background
Paired kidney exchange (PKE) is a therapeutic strategy where two or more pairs of donor and recipient exchange kidneys between themselves in order to avail an immunologically better compatible organ. It is a cheaper option as compared to the complicated and expensive procedures of pretransplant immune desensitization or ABO-incompatible kidney transplan-tation. PKE demands high level of commitment from the patients, donors and the transplantation medical team. This is a report of two-way PKE done in the pioneer transplant institute of Nepal.
Methods
Medical records of patients who had undergone PKE in the institute were retrieved. Necessary data was captured and retrospective analysis of the characteristic data was done.
Results
First two-way PKE was done in February 14, 2018. Six pair of two-way PKE were performed in the last 4 years. Four (66.67%) pairs were due to unavailability of blood group compatible donor in the legitimate living donor pool and two (33.33%) pairs were due to positive tissue crossmatch despite having a blood group compatible donor. Three (25%) recipients and nine (75%) donors were female. Mean age at transplantation was 40.16 (range, 24–63 years). Basiliximab was used as induction agent in one patient who was treated for hepatitis C, while all others were induced with rabbit thymoglobulin. Three had rejec- tion. One had mixed cellular and humoral rejection on day 4 of transplantation. One had a cellular rejection in the ninth month while the other had a humoral insult, after a year of kidney transplant. Eleven (91.6%) of them survived for at least 6 months. Nine (90%) of the 10 patients transplanted at least 12 months before analysis survived at least one year. Of the total 12 patients, two died. Both deaths were both due to sepsis.
Conclusions
PKE is a rationale strategy to reduce the costs of kidney transplantation.