Participation of compatible donor to improve HLA matching can increase kidney transplant rate of O blood group patients

Background

Infection is the most common cause of hospitalization, morbidity, and mortality in post-transplant recipients in developing countries like India. With the availability of potent immunosuppression the short-term graft outcomes have improved, but the risk of infections has increased, and the long-term graft and patient survival are poor. Infections are the leading cause of death with functioning grafts in the developing countries. By increasing the HLA match, we can decrease the need of more potent immunosuppression, thereby decreasing the risk of infection and improving graft and patient survival. Here we report a case where two-way kidney paired donation (KPD) transplantation was done for better HLA match to improve long-term graft survival.

Methods

Two-way kidney paired donation (KPD) transplantation was performed, where one compatible pair (patient: AB blood group 48 years male; Donor, 47 year wife) benefitted by better HLA match (9/14) and other pair (patient: O blood group 33 years female; Donor 47 year mother) benefitted by getting ABO compatible O group donor. Both patients had anatomic, functional, and immunologically comparable donors. Kidney transplant was performed simultaneously after legal permission from authorization committee.

Results

Outcome was similar for both patients. Mean serum creatinine is 0.95 mg/dl at 3 months follow-up without any complications.

Conclusion

National KPD program will expand the donor pool. Long-term outcome of compatible pairs with poor HLA matching can be improved with better HLA matching in KPD, which also increases the transplant rate of KPD program.