NEW YORK (Reuters Health) - A live kidney-paired donation (KPD) program at Johns Hopkins University substantially increased the number of compatible donor kidneys available for transplantation without compromising the quality of the donations, investigators report.

In KPD transplants, incompatible donor/recipient pairs exchange kidneys so that each recipient receives a compatible organ, Dr. Robert A. Montgomery and his associates explain in their report, published in the Journal of the American Medical Association for October 5.

It hasn't been difficult to convince people to participate in the KPD program, Dr. Montgomery told Reuters Health. "People are very open to this concept. Patients are not narrowly focused on receiving a kidney from their loved ones."

On the other hand, "Donors felt they just wanted to see their loved one come off dialysis and lead a normal life," he added, "and the specifics of how that happened was not that important to them, so long as they were aware that they were the agent of making that happen."

The Baltimore-based research team reports that 22 patients received transplants through 10 paired donations. KPD transplants were performed to avoid blood group incompatibility, eliminate a positive crossmatch, improve HLA antigen matching, avoid HLA antigens shared with a previous transplant recipient, or reduce the amount of donor specific anti-HLA antigen antibody.

At a median follow-up of 13 months (range, 1 to 42 months), patient survival rate was 100%, and graft survival was 95.5%.

"A KPD program is the cheapest alternative" for these patients, Dr. Montgomery said, "far cheaper than staying on dialysis and less expensive than removing the antibodies" with plasmapheresis, IV immunoglobulin and splenectomy.

Furthermore, "Our computer simulations show that the more pairs you have in the pool from which matches are made, the greater the percentage of the pool that will get matched," the researcher said, which justifies the establishment of a national KPD program.

"This is the first study in the US to demonstrate that KPD is a very viable option and the outcomes are outstanding," he concluded.

While this approach is an exciting advance in the field of kidney transplantation, it also raises additional concerns, Drs. Arthur J. Matas and David E. R. Sutherland from the University of Minnesota in Minneapolis note in a related editorial.

"Those involved in such programs must pay careful attention to the informed consent process and should be conducting formal follow-up studies of donors," they add.

JAMA 2005;294:1655-1663,1691-1693

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