Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation

Robert A. Montgomery, Andrea A. Zachary, Lloyd E. Ratner, Dorry L. Segev, Janet M. Hiller, Julie Houp, Mathew Cooper, Louis Kavoussi, Thomas Jarrett, James Burdick, Warren R. Maley, J. Keith Melancon, Tomasz Kozlowski, Christopher E. Simpkins, Melissa Lapinska, Amol Desai, Vanessa Collins, Brigitte Reeb, Edward Kraus, Hamid RabbMary S. Leffell, Daniel S. Warren

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Context: First proposed 2 decades ago, live kidney paired donation (KPD) was considered a promising new approach to addressing the shortage of organs for transplantation. Ethical, administrative, and logistical barriers initially proved formidable and prevented the implementation of KPD programs in the United States. Objective: To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. Design, Setting, and Patients: Prospective series of paired donations matched and transplanted from a pool of blood type or crossmatch incompatible donors and recipients with end-stage renal disease (6 conventional and 4 unconventional KPD transplants) at a US tertiary referral center (between June 2001 and November 2004) with expertise in performing transplants in patients with high immunologic risk. Intervention: Kidney paired donation and live donor renal transplantation. Main Outcome Measures: Patient survival, graft survival, serum creatinine levels, rejection episodes. Results: A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up of 13 months (range, 1-42 months), the patient survival rate was 100% and the graft survival rate was 95.5%. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8 mg/dL) (106.1 mu;mol/L [range, 70.7-159.1 mu;mol/L]). There were no instances of antibody-mediated rejection despite the inclusion of 5 patients who were highly sensitized to HLA antigens due to previous exposure to foreign tissue. Four patients developed acute cellular rejection (18%). Conclusions: This series of patients who received transplants from a single-center KPD pool provides evidence that recipients with incompatible live donors, even those with rare blood type combinations or high degrees of HLA antigen sensitization, can receive transplants through KPD with graft survival rates that appear to be equivalent to directed, compatible live donor transplants. If these results can be generalized, broader availability of KPD to the estimated 6000 patients with incompatible donors could result in a large expansion of the donor pool.

Original languageEnglish (US)
Pages (from-to)1655-1663
Number of pages9
JournalJournal of the American Medical Association
Volume294
Issue number13
DOIs
StatePublished - Oct 5 2005

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Tissue Donors
Kidney
Transplants
Graft Survival
Survival Rate
HLA Antigens
Creatinine
Organ Transplantation
Serum
Tertiary Care Centers
Kidney Transplantation
Chronic Kidney Failure
Outcome Assessment (Health Care)
Survival
Antibodies

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Montgomery, R. A., Zachary, A. A., Ratner, L. E., Segev, D. L., Hiller, J. M., Houp, J., ... Warren, D. S. (2005). Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation. Journal of the American Medical Association, 294(13), 1655-1663. https://doi.org/10.1001/jama.294.13.1655

Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation. / Montgomery, Robert A.; Zachary, Andrea A.; Ratner, Lloyd E.; Segev, Dorry L.; Hiller, Janet M.; Houp, Julie; Cooper, Mathew; Kavoussi, Louis; Jarrett, Thomas; Burdick, James; Maley, Warren R.; Melancon, J. Keith; Kozlowski, Tomasz; Simpkins, Christopher E.; Lapinska, Melissa; Desai, Amol; Collins, Vanessa; Reeb, Brigitte; Kraus, Edward; Rabb, Hamid; Leffell, Mary S.; Warren, Daniel S.

In: Journal of the American Medical Association, Vol. 294, No. 13, 05.10.2005, p. 1655-1663.

Research output: Contribution to journalArticle

Montgomery, RA, Zachary, AA, Ratner, LE, Segev, DL, Hiller, JM, Houp, J, Cooper, M, Kavoussi, L, Jarrett, T, Burdick, J, Maley, WR, Melancon, JK, Kozlowski, T, Simpkins, CE, Lapinska, M, Desai, A, Collins, V, Reeb, B, Kraus, E, Rabb, H, Leffell, MS & Warren, DS 2005, 'Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation', Journal of the American Medical Association, vol. 294, no. 13, pp. 1655-1663. https://doi.org/10.1001/jama.294.13.1655
Montgomery, Robert A. ; Zachary, Andrea A. ; Ratner, Lloyd E. ; Segev, Dorry L. ; Hiller, Janet M. ; Houp, Julie ; Cooper, Mathew ; Kavoussi, Louis ; Jarrett, Thomas ; Burdick, James ; Maley, Warren R. ; Melancon, J. Keith ; Kozlowski, Tomasz ; Simpkins, Christopher E. ; Lapinska, Melissa ; Desai, Amol ; Collins, Vanessa ; Reeb, Brigitte ; Kraus, Edward ; Rabb, Hamid ; Leffell, Mary S. ; Warren, Daniel S. / Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation. In: Journal of the American Medical Association. 2005 ; Vol. 294, No. 13. pp. 1655-1663.
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abstract = "Context: First proposed 2 decades ago, live kidney paired donation (KPD) was considered a promising new approach to addressing the shortage of organs for transplantation. Ethical, administrative, and logistical barriers initially proved formidable and prevented the implementation of KPD programs in the United States. Objective: To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. Design, Setting, and Patients: Prospective series of paired donations matched and transplanted from a pool of blood type or crossmatch incompatible donors and recipients with end-stage renal disease (6 conventional and 4 unconventional KPD transplants) at a US tertiary referral center (between June 2001 and November 2004) with expertise in performing transplants in patients with high immunologic risk. Intervention: Kidney paired donation and live donor renal transplantation. Main Outcome Measures: Patient survival, graft survival, serum creatinine levels, rejection episodes. Results: A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up of 13 months (range, 1-42 months), the patient survival rate was 100{\%} and the graft survival rate was 95.5{\%}. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8 mg/dL) (106.1 mu;mol/L [range, 70.7-159.1 mu;mol/L]). There were no instances of antibody-mediated rejection despite the inclusion of 5 patients who were highly sensitized to HLA antigens due to previous exposure to foreign tissue. Four patients developed acute cellular rejection (18{\%}). Conclusions: This series of patients who received transplants from a single-center KPD pool provides evidence that recipients with incompatible live donors, even those with rare blood type combinations or high degrees of HLA antigen sensitization, can receive transplants through KPD with graft survival rates that appear to be equivalent to directed, compatible live donor transplants. If these results can be generalized, broader availability of KPD to the estimated 6000 patients with incompatible donors could result in a large expansion of the donor pool.",
author = "Montgomery, {Robert A.} and Zachary, {Andrea A.} and Ratner, {Lloyd E.} and Segev, {Dorry L.} and Hiller, {Janet M.} and Julie Houp and Mathew Cooper and Louis Kavoussi and Thomas Jarrett and James Burdick and Maley, {Warren R.} and Melancon, {J. Keith} and Tomasz Kozlowski and Simpkins, {Christopher E.} and Melissa Lapinska and Amol Desai and Vanessa Collins and Brigitte Reeb and Edward Kraus and Hamid Rabb and Leffell, {Mary S.} and Warren, {Daniel S.}",
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T1 - Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation

AU - Montgomery, Robert A.

AU - Zachary, Andrea A.

AU - Ratner, Lloyd E.

AU - Segev, Dorry L.

AU - Hiller, Janet M.

AU - Houp, Julie

AU - Cooper, Mathew

AU - Kavoussi, Louis

AU - Jarrett, Thomas

AU - Burdick, James

AU - Maley, Warren R.

AU - Melancon, J. Keith

AU - Kozlowski, Tomasz

AU - Simpkins, Christopher E.

AU - Lapinska, Melissa

AU - Desai, Amol

AU - Collins, Vanessa

AU - Reeb, Brigitte

AU - Kraus, Edward

AU - Rabb, Hamid

AU - Leffell, Mary S.

AU - Warren, Daniel S.

PY - 2005/10/5

Y1 - 2005/10/5

N2 - Context: First proposed 2 decades ago, live kidney paired donation (KPD) was considered a promising new approach to addressing the shortage of organs for transplantation. Ethical, administrative, and logistical barriers initially proved formidable and prevented the implementation of KPD programs in the United States. Objective: To determine the feasibility and effectiveness of KPD for the management of patients with incompatible donors. Design, Setting, and Patients: Prospective series of paired donations matched and transplanted from a pool of blood type or crossmatch incompatible donors and recipients with end-stage renal disease (6 conventional and 4 unconventional KPD transplants) at a US tertiary referral center (between June 2001 and November 2004) with expertise in performing transplants in patients with high immunologic risk. Intervention: Kidney paired donation and live donor renal transplantation. Main Outcome Measures: Patient survival, graft survival, serum creatinine levels, rejection episodes. Results: A total of 22 patients received transplants through 10 paired donations including 2 triple exchanges at Johns Hopkins Hospital. At a median follow-up of 13 months (range, 1-42 months), the patient survival rate was 100% and the graft survival rate was 95.5%. Twenty-one of the 22 patients have functioning grafts with a median 6-month serum creatinine level of 1.2 mg/dL (range, 0.8-1.8 mg/dL) (106.1 mu;mol/L [range, 70.7-159.1 mu;mol/L]). There were no instances of antibody-mediated rejection despite the inclusion of 5 patients who were highly sensitized to HLA antigens due to previous exposure to foreign tissue. Four patients developed acute cellular rejection (18%). Conclusions: This series of patients who received transplants from a single-center KPD pool provides evidence that recipients with incompatible live donors, even those with rare blood type combinations or high degrees of HLA antigen sensitization, can receive transplants through KPD with graft survival rates that appear to be equivalent to directed, compatible live donor transplants. If these results can be generalized, broader availability of KPD to the estimated 6000 patients with incompatible donors could result in a large expansion of the donor pool.

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