Conference Proceeding

Strategies to increase the amount of living kidney donation. The first kidney paired donation and chain kidney paired donation in Poland - single centre experience

Rafal Kieszek ,
Department of General and Transplantation Surgery, Medical University of Warsaw, Poland

Background: As compared with the results of kidney transplantation procured from deceased donors, kidneys harvested from living organ donor provide better graft outcome. Due to the shortage of cadaveric donors, living kidney donation has become the most crucial organ pool. In Poland, the percentage of living kidney donation is still very low and amounts 5%. The Department of General and Transplantation Surgery in Warsaw is the most active transplantation centre in Poland and 50% of all of the living kidney transplantation are performed in here. Unfortunately, not all of the potential kidney donors that report to the transplant centre are compatible with their recipient. In such situation the solution for that problem might be the kidney paired donation (KPD).
Methods: Incompatible living donors for direct kidney donation (DKD) with willing for KPD were added to our computer base that was created for that purpose. Due to legislation in Poland, only closed loops are available (no altruistic donors). Our base in the moment of the first KPD consisted of 28 incompatible pairs for DKD. After 3 years of preparation, the first ABO-compatible KPD was performed in February 2015. Only 10 pairs were a match, however only 2 of them had had a negative cross-match. Recipients that are being qualified for the transplantation are still on the waiting list for the transplantation from the deceased donor, which causes that some of qualified pairs receive a kidney from cadaveric donor prior the date of the transplantation from the LKD. The first chain KPD that consisted of 3 pairs was performed in June 2015. One of the pairs was ABO incompatible. All of the recipients received induction immunosuppressive therapy.
Results: Good results of kidney transplantation were achieved. No acute rejection episodes were observed. One delayed graft function was noted; the patient required 2 procedures of hemodialysis post transplantation. In the KPD cohort the mean serum creatinine concentration was 1mg/dl in the whole follow-up period and in the chain KPD group: 1,3 mg/dl after 1 month, 1,26 (3 months), 1,21 mg/dl (6 months), 1,03 mg/dl (9 months) and 1,05 mg/dl (12 months). The lowest serum creatinine concentration and hence the best kidney function has the ABO incompatible kidney recipient. Donors are also included in the follow-up program. Neither surgical complications, nor statistically significant kidney function decrease were observed. The mean creatinine serum concentration after 1, 3, 6, 9 and 12 months was as followed: 1,3 mg/dl, 1,2 mg/dl, 1,15 mg/dl, 1,15 mg/dl and 1 mg/dl, as long as the donors from KPD are concerned. Chain KPD donors’ serum creatinine level was higher: 1, 63 mg/dl, 1,43 mg/dl, 1,53 mg/dl, 1,4 mg/dl and 1,43 mg/dl post 12 months.
Conclusion: KPD is associated with the augmentation of the number of living kidney transplantation performed. Moreover, the good outcomes, as long as the recipients and donors are concerned, are attainable, also in the ABO incompatible transplantations. The first successful paired donation gave an opportunity for further development of that program. Moreover, it should allow better match of donor and recipient in the near future.

Published: 28 April 2017