Five years of single-center experience with paired kidney exchange transplantation

Introduction. Due to the organ shortage, living donor transplantation has become a method to bridge the gap. Paired kidney exchange program (PKEP) is a viable method especially when there are incompatible related living donors. Even if there are still some unanswered questions, this program is current in some centers, and there appears to be a tendency to extend it in Europe. The aim of our study was to assess our results with PKEP after 5 years. Methods. Between January 2001 and December 2005, we performed 56 living donor kidney transplantations using this method. We performed 26 kidney exchange procedures: 23 with two pairs, two with three pairs, and one with four pairs. Extensive preoperative work was necessarily to obtain equivalent pairs from the anatomic, functional, and immunological points of view. The same team performed all transplants. The mean recipient age was 35.59 years (range 29 to 44). Mean waiting time for a renal transplant was 33.27 months (range 11 to 87). Results. At a median follow-up of 41 months (range 7 to 59), the rates of acute rejection and graft survival-19.64% and 98.21%-were similar to direct living donation-14.66% and 97.92%, respectively (P = .35 and .88, respectively). Conclusion. The paired kidney exchange program is a viable procedure medically and economically, which can be promoted in centers with a low deceased donor transplantation rate and a high number of incompatible related donors.