[Living donor kidney transplant: the crossover modality]

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Innovation

Context:

• Living donor kidney transplantation (LKD) is the optimal choice for end-stage renal disease (ESRD) patients due to superior organ quality and survival rates.
• ABO incompatibility and positive cross-matches are significant barriers to LKD, limiting options for many patients.
• Advancements in immunosuppression, apheresis, and immunoglobulin therapy aim to overcome these biological hurdles.

Purpose:

• To evaluate the efficacy and clinical outcomes of paired exchange living donor kidney transplantation (PE-LKD) as a strategy to overcome immunological barriers.
• To highlight the role of international and national paired exchange programs in facilitating LKD.
• To present the Italian experience with PE-LKD, including early national and center-specific initiatives.

Summary:

• Paired exchange LKD involves exchanging incompatible donor-recipient pairs to enable transplantation.
• International guidelines recommend paired exchange to circumvent blood type and cross-match incompatibilities.
• The first Italian PE-LKD occurred in 2005, followed by a national program in 2006, demonstrating successful implementation.

Impact:

• PE-LKD provides a viable solution for ESRD patients facing immunological incompatibility, expanding access to LKD.
• Clinical results from paired exchange programs are comparable to direct LKD, offering comparable survival benefits.
• This approach enhances the quality of life for uremic patients by enabling otherwise impracticable kidney transplants.