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Paired kidney exchange

Lung-Yi Lee, Thomas A Pham, Marc L Melcher
End-stage renal disease (ESRD) is a significant health care burden. Although kidney transplantation is the optimal treatment modality, less than 25% of waiting list patients are transplanted because of organ shortage. Living kidney donation can lead to better recipient and graft survival and increase the number of donors. Not all ESRD patients have potential living donors, and not all living donors are a compatible match to recipients. Kidney paired exchanges allow incompatible pairs to identify compatible living donors for living donor kidney transplants for multiple recipients...
February 2019: Surgical Clinics of North America
Laura Riesco, Juan Irure, Emilio Rodrigo, Sandra Guiral, Juan Carlos Ruiz, Javier Gómez, Marcos López-Hoyos, David San Segundo
BACKGROUND: The improvement in the definition of serum anti-HLA antibodies (HLA-Abs) profiles after Luminex-assay implementation in transplant patients follow-up is clear. This success has permitted the development of hypersensitized-recipient allocation and donor-paired exchange programs improving the access to transplantation. However, non-HLA Abs have been described in transplanted patients but their effect in hypersensitized transplanted recipients is unclear. METHODS: Twenty-seven HLA hypersensitized patients awaiting for kidney transplantation (KT) were studied and 11 of them were followed after KT...
November 17, 2018: Transplant Immunology
Jenny Hc Chen, Peter Hughes, Claudia Woodroffe, Paolo Ferrari
Baseline pre-donation eGFR appears to predict the risk of post-donation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90ml/min/1.73m2 as an acceptable level of GFR for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1-year follow-up linking records in the AKX database and ANZDATA...
October 24, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Mathieu Bray, Wen Wang, Peter X-K Song, John D Kalbfleisch
In kidney paired donation (KPD), incompatible donor-candidate pairs and non-directed (also known as altruistic) donors are pooled together with the aim of maximizing the total utility of transplants realized via donor exchanges. We consider a setting in which disjoint sets of potential transplants are selected at regular intervals, with fallback options available within each proposed set in the case of individual donor, candidate or match failure. We develop methods for calculating the expected utility for such sets under a realistic probability model for the KPD...
April 2018: Statistics in Biosciences
Danielle N Bozek, Ty B Dunn, Christian S Kuhr, Christopher L Marsh, Jeffrey Rogers, Susan E Rees, Laura Basagoitia, Robert J Brunner, Alvin E Roth, Obi Ekwenna, David E Fumo, Kimberly D Krawiec, Jonathan E Kopke, Puneet Sindhwani, Jorge Ortiz, Miguel Tan, Siegfredo R Paloyo, Jeffrey D Punch, Michael A Rees
BACKGROUND: Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens. OBJECTIVE: While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015...
March 2018: European Urology Focus
Courtenay M Holscher, Kyle Jackson, Alvin G Thomas, Christine E Haugen, Sandra R DiBrito, Karina Covarrubias, Sommer E Gentry, Matthew Ronin, Amy D Waterman, Allan B Massie, Jacqueline Garonzik Wang, Dorry L Segev
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%)...
November 2018: American Journal of Transplantation
Alessio Bocedi, Giada Cattani, Lorenzo Stella, Renato Massoud, Giorgio Ricci
Human serum albumin (HSA) is characterized by 17 disulfides and by only one unpaired cysteine (Cys34 ), which can be free in the reduced albumin or linked as a mixed disulfide with cysteine, or in minor amount with other natural thiols, in the oxidized albumin. In healthy subjects, the level of the oxidized form is about 35%, but it rises up to 70% after oxidative insults or in patients with kidney diseases. Oxidized albumin is therefore considered a short-term biomarker of oxidative stress as its level may increase or decrease under appropriate redox inputs in discrete temporal spans...
September 2018: FEBS Journal
Congcong Zhang, Jian Hu, Fengmei Sun, Man Jia, Gang Chen, Cuiling Wu, Lufei Zheng
RATIONALE: An analytical method for gentamicin in animal tissues was developed and validated. An alkaline mobile phase with an HPH C8 column was selected so that all the four gentamicin components were retained and eluted without using fluorinated ion-pairing reagents. METHODS: The method is sufficiently sensitive and highly selective, using a strong cation-exchange solid-phase extraction cartridge (PCX) to clean up the samples. Different types of solid-phase extraction columns and membranes were considered to obtain a high recovery...
October 30, 2018: Rapid Communications in Mass Spectrometry: RCM
Hyunwoo Lee, Seokhyun Chung, Taesu Cheong, Sang Hwa Song
Kidney exchange programs, which allow a potential living donor whose kidney is incompatible with his or her intended recipient to donate a kidney to another patient in return for a kidney that is compatible for their intended recipient, usually aims to maximize the number of possible kidney exchanges or the total utility of the program. However, the fairness of these exchanges is an issue that has often been ignored. In this paper, as a way to overcome the problems arising in previous studies, we take fairness to be the degree to which individual patient-donor pairs feel satisfied, rather than the extent to which the exchange increases social benefits...
July 14, 2018: International Journal of Environmental Research and Public Health
Vivek B Kute, Narayan Prasad, Pankaj R Shah, Pranjal R Modi
Kidney exchange transplantation is well established modality to increase living donor kidney transplantation. Reasons for joining kidney exchange programs are ABO blood group incompatibility, immunological incompatibility (positive cross match or donor specific antibody), human leukocyte antigen (HLA) incompatibility (poor HLA matching), chronological incompatibility and financial incompatibility. Kidney exchange transplantation has evolved from the traditional simultaneous anonymous 2-way kidney exchange to more complex ways such as 3-way exchange, 4-way exchange, n -way exchange,compatible pair, non-simultaneous kidney exchange,non-simultaneous extended altruistic donor, never ending altruistic donor, kidney exchange combined with desensitization, kidney exchange combined with ABO incompatible kidney transplantation, acceptable mismatch transplant, use of A2 donor to O patients, living donor-deceased donor list exchange, domino chain, non-anonymous kidney exchange, single center, multicenter, regional, National, International and Global kidney exchange...
June 28, 2018: World Journal of Transplantation
L S Baines, H Dulku, R M Jindal, V Papalois
INTRODUCTION: Despite excellent outcomes of kidney paired donation (KPD), little is known about how a patient's frame (apply cognitive bias) or weight (attribute value) and concerns relating to risk, justice, and equity affect his or her decision-making process. MATERIALS AND METHODS: A pilot study consisting of 3 KPD transplant recipients and 3 KPD kidney donors in the last year was conducted to identify and explore themes in decision making and risk taking. The pilot study was followed by the main study comprised of 20 recipients who had already undergone KPD transplantation and 20 donors who had undergone donor nephrectomy...
June 2018: Transplantation Proceedings
Jian Y Cheng, Andrew Martin, Ganesh Ramanathan, Bruce A Cooper
Background: Screening potential live kidney donors is an intense process for both candidates and the healthcare system. It is conventionally implemented using a standard generic protocol. Efficiencies in this process could potentially be achieved using personalized protocols that are optimized for a given candidate. Aim: To create personalized protocols (by age, sex, and paired exchange status) and evaluate them relative to the standard generic protocol. Methods: Two personalized protocols were created...
May 2018: Transplantation Direct
Evelyn M Tenenbaum
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors...
March 2018: American Journal of Law & Medicine
Eslam Hamouda, Sara El-Metwally, Mayada Tarek
The kidney exchange programs bring new insights in the field of organ transplantation. They make the previously not allowed surgery of incompatible patient-donor pairs easier to be performed on a large scale. Mathematically, the kidney exchange is an optimization problem for the number of possible exchanges among the incompatible pairs in a given pool. Also, the optimization modeling should consider the expected quality-adjusted life of transplant candidates and the shortage of computational and operational hospital resources...
2018: PloS One
Thomas McGregor, Alp Sener, Steven Paraskevas, Brian Reikie
Kidney paired donation (KPD) programs are an effort to bridge the disparity between kidney supply and demand. These programs combine several incompatible donor-recipient pairs in a national paired exchange database, thereby increasing the number of compatible matches. But KPD programs face unique challenges, particularly the large distances that often separate donors and recipients. Here we discuss key factors to consider when transitioning from a donor travelling model to a kidney shipment model in the Canadian context...
April 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Benjamin Samstein, Inmaculada de Melo-Martin, Sandip Kapur, Lloyd Ratner, Jean Emond
Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to the donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney...
May 2018: American Journal of Transplantation
Courtenay M Holscher, Kyle Jackson, Eric K H Chow, Alvin G Thomas, Christine E Haugen, Sandra R DiBrito, Carlin Purcell, Matthew Ronin, Amy D Waterman, Jacqueline Garonzik Wang, Allan B Massie, Sommer E Gentry, Dorry L Segev
Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while experiencing the morbidity of dialysis. The balance between waiting for KPD vs desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multicenter KPD clearinghouse, between October 2011 and September 2015 using a competing-risk framework...
June 2018: American Journal of Transplantation
Ashish Mishra, Alexis Lo, Grace S Lee, Benjamin Samstein, Peter S Yoo, Matthew H Levine, David S Goldberg, Abraham Shaked, Kim M Olthoff, Peter L Abt
Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE...
May 2018: Liver Transplantation
Thomas McGregor, Alp Sener, Steven Paraskevas, Brian Reikie
Kidney paired donation (KPD) programs are an effort to bridge the disparity between kidney supply and demand. These programs combine several incompatible donor-recipient pairs in a national paired exchange database, thereby increasing the number of compatible matches. But KPD programs face unique challenges, particularly the large distances that often separate donors and recipients. Here we discuss key factors to consider when transitioning from a donor travelling model to a kidney shipment model in the Canadian context...
January 24, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Dongkyu Oh, Eun Suk Kang, Shinae Yu, Kyoungsuk Chun, Wooseong Huh, Hye Ryoun Jang, Chan Woo Cho, Nuri Lee, Kyo Won Lee, Hyojun Park, Jae Berm Park, Sung Joo Kim
As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings...
January 29, 2018: Journal of Korean Medical Science
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