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World Journal of Clinical Cases 2016年第10期4卷 351-355页

作者： Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Manisha P Modi Priya S Shah Umesh T Varyani Pavan S Wakhare Saiprasad G Shinde Viajay A Ghodela Minaxi H Patel Varsha B trivedi hargovind l.trivedi Department of Nephrology and Clinical Transplantation Institute of Kidney Diseases and Research CenterDr.HL Trivedi Institute of Transplantation Sciences(IKDRC-ITS) Department of Urology and Transplantation IKDRC-ITS Department of Anesthesia IKDRC-ITS Department of Pathology Laboratory MedicineTransfusion Services and ImmunohematologyIKDRC-ITS

The combination of kidney paired donation(KPD) with desensitization represents a promising method of increasing the rate of living donor kidney transplantation(lDKT) in immunologically challenging patients. Patients who are difficult to match and desensitize due to strong donor specific antibody are may be transplanted by a combination of desensitization and KPD protocol with more immunologically favorable donor. We present our experience of combination of desensitization protocol with three-way KPD which contributed to successful lDKT in highly sensitized end stage renal disease patient. All recipients were discharged with normal and stable allograft function at 24 mo follow up. We believe that this is first report from India where three-way KPD exchange was performed with the combination of KPD and desensitization. The combination of desensitization protocol with KPD improves access and outcomes of lDKT.

关键词： Kidney failure Chronic Desensitization Immunologic Kidney transplantation Blood group incompatibility living donors Tissue and organ procurement

Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India

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World Journal of Nephrology 2016年第6期5卷 531-537页

作者： Vivek B Kute Himanshu V Patel Umesh T Varyani Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Priya S Shah Pavan S Wakhare Vijay A Ghodela Saiprasad G Shinde Varsha B trivedi Minaxi H Patel hargovind l.trivedi Department of Nephrology and Clinical Transplantation Institute of Kidney Diseases and Research Center Dr HL Trivedi Institute of Trans-plantation Sciences Department of Urology and Transplantation Dr HL Trivedi Institute of Trans-plantation Sciences Department of Anesthesia Dr HL Trivedi Institute of Transplantation Sciences Department of Pathology and laboratory medicine Dr HL Trivedi Institute of Transplantation Sciences

AIM To avoid desensitization protocols and ABO incompatible kidney transplantation(KT) due to high costs and increased risk of infections from intense *** We present institutional ethical review board- approved study of single center 6-way kidney exchange transplantation. The participants comprised ABO incompatibility(n = 1); positive cross-match and/or presence of donor specific antibody(n = 5). The average time required from registration in kidney paired donation(KPD) registry to find suitable donors was 45 d and time required to perform transplants after legal permission was 2 mo. RESUlTS Graft and patient survival were 100%, and 100%, respectively. One patient had biopsy-proven acute borderline T cell rejection(Banff update 2013, type 3). Mean serum creatinine was 0.8 mg/dl at 9 mo followup. The waiting time in KPD was short as compared to deceased donor KT. CONClUSION We report first non-simultaneous, single center, 6-way kidney exchange transplantation from India. Our experience will encourage other centers in India to undertake this practice.

关键词： Kidney transplantation/methods Kidney paired donation living donors/supply and distribution Donor selection/methods

Past, present and future of kidney paired donation transplantation in India

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World Journal of Transplantation 2017年第2期7卷 134-143页

作者： Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Manisha P Modi Priya S Shah Umesh T Varyani Pavan S Wakhare Saiprasad G Shinde Vijay A Ghodela Minaxi H Patel Varsha B trivedi hargovind l.trivedi Department of Nephrology and Clinical Transplantation Institute of Kidney Diseases and Research CentreDr HL Trivedi Institute of Transplantation Sciences(IKDRC-ITS) Department of Urology and transplantation Department of Anaesthesia IKDRC-ITS Department of Pathology Laboratory MedicineTransfusion Services and Immunohematology

One third of healthy willing living kidney donors are rejected due to ABO blood group incompatibility and donor specific antibody. This increases pre-transplant dialysis duration leading to increased morbidity and mortality on the kidney transplantation waiting list. Over the last decade kidney paired donation is most rapidly increased source of living kidney donors. In a kidney transplantation program dominated by living donor kidney transplantation, kidney paired donation is a legal and valid alternative strategy to increase living donor kidney transplantation. This is more useful in countries with limited resources where ABO incompatible kidney transplantation or desensitization protocol is not feasible because of costs/infectious complications and deceased donor kidney transplantation is in initial stages. The matching allocation, ABO blood type imbalance, reciprocity, simultaneity, geography were the limitation for the expansion of kidney paired donation. Here we describe different successful ways to increase living donor kidney transplantation through kidney paired donation. Compatible pairs, domino chain, combination of kidney paired donation with desensitization or ABO incompatible transplantation, international kidney paired donation, nonsimultaneous, extended, altruistic donor chain and list exchange are different ways to expand the donor *** absence of national kidney paired donation program,a dedicated kidney paired donation team will increase access to living donor kidney transplantation in individual centres with team work. Use of social networking sites to expand donor pool, HlA based national kidney paired donation program will increase quality and quantity of kidney paired donation transplantation. Transplant centres should remove the barriers to a broader implementation of multicentre, national kidney paired donation program to further optimize potential of kidney paired donation to increase transplantation of O group and sensitized patients. T

关键词： living donor kidney transplantation Kidney paired donation Renal replacement therapy Developing country

International kidney paired donation transplantations to increase kidney transplant of O group and highly sensitized patient: First report from India

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World Journal of Transplantation 2017年第1期7卷 64-69页

作者： Vivek B Kute Himanshu V Patel Pankaj R Shah Pranjal R Modi Veena R Shah Sayyed J Rizvi Bipin C Pal Priya S Shah Pavan S Wakhare Saiprasad G Shinde Vijay A Ghodela Umesh T Varyani Minaxi H Patel Varsha B trivedi hargovind l.trivedi Department of Nephrology and Clinical Transplantation Institute of Kidney Diseases and Research Center Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS) Department of Urology and transplantation IKDRC-ITS Department of Anesthesia IKDRC-ITS Department of Pathology Laboratory Medicine Transfusion Services and Immunohematology IKDRC-ITS

AIM To report the first international living related two way kidney paired donation(KPD) transplantation from India which occurred on 17 th February 2015 after legal per-mission from authorization committee. METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-matchand donor specific antibody in two way kidney exchange with the intended KPD donor. local KPD options were fully explored for Indian patient prior to embarking on international KPD. RESUlTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/d l on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our *** International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.

关键词： Kidney paired donation International kidney paired donation living donor kidney transplantation