Faculty Bibliography

Purpose of review. As the demand for organs continues to exceed the supply, the number of days spent waiting for a kidney transplant increases exponentially, particularly for patients who are broadly sensitized to allo-human leukocyte antigen molecules or have difficult to match blood types. In an effort to optimize organ availability and offer the benefit of renal transplantation to these patients, several transplant centers have developed protocols to overcome sensitization and blood group incompatibilities. Recent findings. In addition to plasmapheresis and intravenous immunoglobulin, therapies like splenectomy and anti-CD20 were thought to be essential to the long-term engraftment of incompatible organs. The advent of more focused and powerful maintenance immunosuppression regimens that include agents with B-cell anti proliferative properties have produced excellent results without the need for long-term ablation of the B-cell compartment, reducing the risk of infectious and neoplastic complications. Summary. The advent of high-dose intravenous immunoglobulin and plasmapheresis/low-dose intravenous immunoglobulin desensitization protocols have permitted renal transplantation across both ABO-incompatible and -positive donor-specific crossmatch barriers and allowed patients excluded from access to transplantation the opportunity to enjoy the many benefits of freedom from dialysis.

Purpose of review. The aim of this article is to review all publications regarding kidney paired donation published over the past 2 years and in doing so provide an evaluation of the current state of development of the field. Recent findings. A few large multicenter paired donation consortia have been developed, and using computer-based matching algorithms have entered significant numbers of donor-recipient pairs (although no program to date has conducted computer match runs with over 75donor-recipient pairs). In addition, significant progress has been made in developing innovative matching strategies and in modeling potential results of paired donation programs. Despite these advances, these programs have only scratched the surface of the estimated potential of paired donation programs to increase living kidney donation. The greatest effects on increasing volume can be made by increasing donor/recipient identification and enrolment. Summary. Significant advances have been made in clinical experience and technological development of paired donation programs. Technical advances have occurred, however, at a more rapid pace than clinical advances in paired donation. Significant work with respect to ethical and educational foundations needs to be accomplished to close this gap.