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Outcome of Multipair Donor Kidney Exchange by a Web-Based Algorithm

Beom Seok Kim^*, Yu Seun Kim, Soon Il Kim, Myoung Soo Kim, Ho Yung Lee^*, Yong-Lim Kim, Chan Duck Kim, Chul Woo Yang, Bum Soon Choi, Duck Jong Han^||, Yon Su Kim^¶, Sung Joo Kim^**, Ha-Young Oh and Dae Joong Kim

Departments of ^* Internal Medicine and Surgery, Institute of Kidney Disease, Yonsei University College of Medicine, Department of Internal Medicine, The Catholic University of Korea, Medical College, ^|| Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, ^¶ Department of Internal Medicine, Seoul National University, College of Medicine, ^** Department of Transplantation Surgery and Division of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, and Division of Nephrology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea

Address correspondence to: Dr. Dae Joong Kim, Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Phone: +82-2-3410-3441; Fax: +82-2-3410-3849; E-mail: kimdjsmc{at}dreamwiz.com, kimdjmed{at}hanmail.net

Received for publication October 1, 2006. Accepted for publication December 12, 2006.

Donor kidney exchange is an established method to overcome incompatibility of donor–recipient pairs (DRP). A computerized algorithm was devised to exchange donor kidney and was tested in a multicenter setting. The algorithm was made according to the consensus of participating centers. It makes all possible exchange combinations not only between two incompatible DRP but also circularly among three DRP and selects an optimum set of exchange combinations, considering several factors that can affect the outcome of the exchanged transplant. The algorithm was implemented as a web-based program, and matching was performed five times. Fifty-three DRP were enrolled from five transplant centers. The numbers of DRP that were enrolled in each matching were 38 (25:13), 39 (34:5), 33 (31:2), 32 (28:4), and 34 (30:4) (carryover:newcomer). The numbers of generated exchange combinations were 4:11, 3:17, 2:12, 2:3, and 2:3 (two-pair exchange:three-pair exchange), and the numbers of DRP in selected exchange combinations were six, 12, six, five, and four in each matching. The numbers of DRP with blood type O recipient or AB donor were five and one, respectively, in selected exchange combinations. Six DRP of two-pair exchange combinations and six DRP of three-pair exchange combinations underwent transplantation successfully. Computerized algorithm of donor kidney exchange was tried not only between two incompatible DRP but also circularly among three DRP. It showed that the algorithm has potential to improve the outcome of donor kidney exchange, especially for disadvantaged DRP with blood type O recipients or AB donors.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673