Perioperative Management of 6-way Simultaneous Paired Kidney Exchange Transplantation – An Observational Study

Abstract

Objective: The presence of donor-specific antigens (human leukocyte antigen [HLA] incompatibility) leads to positive T-cell or B-cell crossmatch. Kidney transplant after desensitization protocols not only poses a financial burden on the patients but also there is an increased rate of infections and graft rejection. Paired kidney exchange (PKE) is cost-effective and offers better postoperative graft outcome. Methods: We included six pairs of kidney transplant donors and recipients for 6-way simultaneous PKE transplantation. These patients were ABO incompatible or HLA incompatible or both. Results: All patients underwent transplant in a single day without any perioperative surgical and anesthesia complications except for the need of mechanical ventilation in one patient in the postoperative care unit. The graft function was excellent in all recipients. Conclusion: This is the first 6-way simultaneous kidney exchange transplantation in the northwestern region of India. The inclusion of multiple donors and recipients for a paired exchange kidney transplant, although challenging, increases the donor pool and decreases the waiting time and financial constraints.

Keywords

• blood group incompatibility
• end-stage kidney disease
• graft survival
• kidney transplantation