Introduction: Kidney transplantation is the preferred treatment for end-stage renal disease, but organ scarcity can result in long waiting times. Living-donor kidney transplantation offers an ...alternative to deceased donation, but HLA or AB0 incompatibility can pose a significant obstacle. This study aimed to show the results achieved by a portuguese hospital since its integration into an international cross-over program, the South Alliance for Transplants (SAT). Methods: The SAT program was founded in 2017 and is composed of ten Spanish hospitals, three Italian hospitals and one Portuguese hospital. The program runs every 4 months and enrolled only pairs that were incompatible. Organ transportation is carried out in partnership with the Portuguese Air Force. Results: Three distinct cross-over kidney transplants were performed in partnership with three Spanish hospitals, culminating in the transplantation of three Portuguese patients out of a total of seven patients. The first swap was performed in March 2020, at the beginning of the COVID-19 pandemic, in partnership with two Portuguese and one Spanish hospital. It involved one donor/recipient pair from each country, with AB0 incompatibility between the Portuguese donor and recipient, and no complications were reported. The second swap occurred in December 2021, with three donor/recipient pairs (one Portuguese, where the recipient presented anti-donor antibodies and positive crossmatch with the potential donor, and two from two Spanish hospitals). It was complicated by type-IB cellular rejection in the Portuguese recipient, one week after transplantation, which was treated with corticosteroid therapy. The third swap, also in December 2021, involved two donor/recipient pairs (one Portuguese and one Spanish). It was complicated by delayed renal function due to acute tubular necrosis (histological diagnosis) in the Portuguese recipient. At follow-up, the patients‘ serum creatinine levels were within normal limits, and no other unexpected outcomes were recorded. Conclusion: SAT program has allowed some successful cross-over kidney transplants, probably improving the outcomes of kidney transplantation in Portugal. The expansion of such programs may contribute to a more efficient use of the available resources, increasing the number of transplants performed and reducing waiting times
Kidney Exchange Programs (KEP) are valuable tools to increase the options of living donor kidney transplantation for patients with end-stage kidney disease with an immunologically incompatible live ...donor. Maximising the benefits of a KEP requires an information system to manage data and to optimise transplants. The data input specifications of the systems that relate to key information on blood group and Human Leukocyte Antigen (HLA) types and HLA antibodies are crucial in order to maximise the number of identified matched pairs while minimising the risk of match failures due to unanticipated positive crossmatches. Based on a survey of eight national and one transnational kidney exchange program, we discuss data requirements for running a KEP. We note large variations in the data recorded by different KEPs, reflecting varying medical practices. Furthermore, we describe how the information system supports decision making throughout these kidney exchange programs.
Despite all efforts, the demand for organs increases. New and better strategies are still needed, critical in a crisis like pandemics.
A mathematical approach that integrates need, Opportunity, and ...Accessibility to kidney transplantation, was created. NOA method, corresponds to the lateral surface area of a trigonal pyramid with the need, Opportunity, and Accessibility as axis, resulting in an intuitional chart output (NOA chart) and a percentage score (NOA score). Higher NOA scores are associated with larger NOA chart areas.
We found some natural variability among the European Member States regarding Need, Opportunity, and Accessibility to kidney transplantation, concomitant with NOA scores. In 2019, in the European Union, 129 patients pmp on the waiting list for a kidney transplant were registered, 47 kidneys pmp were procured, and 36 kidneys pmp were transplanted, corresponding to 25% of kidney transplantation's response capacity.
Transplantation is frequently the better treatment for end-stage kidney failure. NOA method may be, in the future, an indicator for evaluating the overall transplantation performance regarding the need for it and a tool for policy definition. With NOA method we seek to contribute for: •A transplantation overall performance normalizing score;•Transplantation response capacity evaluation.
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Summary
Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at ...providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.
The inclusion of compatible pairs within kidney paired exchange programs has been described as a way to enhance these programs. Improved immunological matching for the recipient in compatible pair ...has been described to be a possible benefit.
The main purpose of our study was to determine if the introduction of compatible pairs in the Portuguese kidney paired exchange program would result in a better match for these patients, but also to assess if this strategy would increase the number of incompatible pairs with a possible match.
We included 17 compatible pairs in kidney paired exchange pool of 35 pairs and performed an in-silico simulation determining HLA eplet mismatch load between the co-registered and matched pairs using HLA MatchMaker, version 3.0.
Our study showed that the inclusion of fully HLA-A, -B, −DR mismatched compatible pairs within the national Portuguese KEP increased matched rate within ICP (0.71%) and improved HLA eplet matching within compatible pairs. 16 of 17 (94.12%) of the CP obtained one or more transplants possibilities and 13 (81.25%) would have been transplanted with significantly lower HLA class I and class II total and antibody-verified eplet mismatch load (83.9 ± 16.9 vs. 59.8 ± 12.2, P = .002 and 30.1 ± 5.5 vs. 21.2 ± 3.0, P = .003, respectively).
This strategy is a viable alternative for compatible pairs seeking a better matched kidney and Portuguese KEP program should allow them this possibility.
Introdução: O transplante renal é o tratamento preferencial da doença renal crônica terminal, porém, a escassez de órgãos pode resultar em longos tempos de espera. O transplante renal de doador vivo ...oferece uma alternativa ao doador cadáver, mas a incompatibilidade HLA ou AB0 pode representar um obstáculo significativo. Este estudo teve como objetivo mostrar os resultados alcançados por um hospital português desde sua integração num programa internacional de doação cruzada, o South Alliance for Transplants (SAT). Métodos: O programa SAT foi fundado em 2017 e é composto por dez hospitais espanhóis, três hospitais italianos e um hospital português. O programa ocorre a cada 4 meses e inscreve apenas pares que são incompatíveis. O transporte de órgãos é realizado em parceria com a Força Aérea Portuguesa. Resultados: Foram realizados três cruzamentos distintos em parceria com três hospitais espanhóis, culminando no transplante de três doentes portugueses de um total de sete doentes. O primeiro cruzamento foi realizado em março de 2020, no início da pandemia de COVID-19, com a parceria de dois hospitais portugueses e um hospital espanhol, envolvendo 1 par doador/recetor de cada país, em que o português apresentava incompatibilidade AB0 e onde não se registraram complicações. O segundo ocorreu em dezembro de 2021 com 3 pares doador/receptor (1 português em que o recetor apresentava anticorpos anti-dador e crossmatch positivo com o potencial doador; e 2 de dois hospitais espanhóis), complicado com rejeição celular tipo-IB uma semana após o transplante no receptor português, tratada com corticoterapia. O terceiro cruzamento ocorreu também em dezembro de 2021 com 2 pares doador/recetor (1 português e 1 espanhol), complicado com atraso na função renal por necrose tubular aguda (diagnóstico histológico) na receptora portuguesa. Durante o follow-up, os níveis de creatinina sérica dos doentes mantiveram-se dentro dos limites normais, e não foram registradas outras intercorrências. Conclusão: O programa SAT permitiu a realização de alguns transplantes renais cruzados bem-sucedidos, provavelmente melhorando os resultados do transplante renal em Portugal. A expansão de programas semelhantes pode contribuir para um uso mais eficiente dos recursos disponíveis, aumentando o número de transplantes realizados e reduzindo os tempos de espera.
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