Kidney paired donation: principles, protocols and programs

Area of Science:

• Nephrology
• Transplantation Immunology
• Public Health

Background:

• The persistent shortage of deceased-donor organs necessitates innovative living donation strategies.
• Antibody-incompatible transplants and kidney paired donation (KPD) programs are key strategies to increase kidney transplantation rates.
• Kidney paired donation facilitates transplants for candidates with incompatible living donors by matching them with other incompatible pairs.

Purpose of the Study:

• To review recent advancements in kidney paired donation (KPD).
• To compare differences and commonalities among four national KPD programs.
• To highlight the importance of large, multicenter KPD registries for improving transplant access, especially for highly sensitized patients.

Main Methods:

• Review of recent progress in kidney paired donation (KPD).
• Comparative analysis of four distinct national KPD programs.
• Focus on the use of sophisticated algorithms for donor-recipient matching and multiway exchanges in multicenter KPD.

Main Results:

• Multicenter KPD programs have significantly advanced kidney transplantation over the past decade.
• Large KPD registries are essential for providing access to more potential donors, benefiting difficult-to-match and sensitized patients.
• Sophisticated algorithms are employed in multicenter KPD to optimize donor-recipient matching and minimize immunologic risks through complex exchanges.

Conclusions:

• Kidney paired donation, particularly multicenter programs, represents a highly promising avenue for increasing kidney transplant rates.
• Access to larger donor pools through national registries is vital for overcoming immunologic barriers and improving outcomes for complex transplant candidates.
• Understanding the nuances and shared principles across different national KPD programs can further optimize these essential donation strategies.