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Exchange living-donor kidney transplantation: Merits and limitations

 Kyu Ha Huh  ;  Myoung Soo Kim  ;  Man Ki Ju  ;  Hye Kyung Chang  ;  Hyung Joon Ahn  ;  Su Hyung Lee  ;  Jong Hoon Lee  ;  Soon Il Kim  ;  Yu Seun Kim  ;  Kiil Park 
 TRANSPLANTATION, Vol.86(3) : 430-435, 2008 
Journal Title
Issue Date
ABO Blood-Group System ; Adult ; Blood Group Incompatibility ; Blood Grouping and Crossmatching* ; Female ; Graft Survival*/immunology ; HLA Antigens/analysis ; Humans ; Kidney Transplantation* ; Korea ; Living Donors/supply & distribution* ; Lymphocytes/immunology ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care)* ; Program Evaluation ; Time Factors ; Tissue and Organ Procurement/organization & administration* ; Treatment Outcome
Exchange donor ; Living donor kidney transplantation ; Expansion of the donor pool
BACKGROUND: The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce.

METHODS: From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program.

RESULTS: The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007).

CONCLUSION: We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Ahn, Hyung Joon(안형준)
Chang, Hye Kyung(장혜경)
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
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