Abstract：
BACKGROUND: Live donor kidney transplantation is considered the optimal choice for renal replacement therapy, providing established benefits, such as superior patient survival and improved quality of life. However, immunological challenges, including ABO blood group incompatibility and, particularly, donor-specific HLA antibodies, may impact long-term outcomes considerably or even prevent safe direct transplantation with the intended donor.
METHODS: In this review, the authors discuss kidney paired donation (KPD) as a viable strategy to overcome immunological barriers to living donation through organ exchanges. We thereby lay special focus on the Czech-Austrian transnational KPD program.
RESULTS: While the benefits of KPD programs are well established for adult recipients, recent data suggest that this may hold true also for pediatric patients. Complex algorithms, considering factors like the intricate patterns of HLA sensitization, play a pivotal role in predicting suitable matches, but for pediatric patients also non-immunological factors including age and weight match may play a role. As pool size proves crucial for program efficacy, several countries in Europe have now initiated transnational collaborations to maximize match rates. Among those, the Czech-Austrian transnational joint program, established in 2015 and now expanded to a cooperation with the Israel transplant program to further increase transplant rates, represents a successful example.
CONCLUSIONS: KPD programs, with their innovative approaches and international partnerships, hold promise for enhancing outcomes and addressing the increasing demand for kidney transplantation.
METHODS: In this review, the authors discuss kidney paired donation (KPD) as a viable strategy to overcome immunological barriers to living donation through organ exchanges. We thereby lay special focus on the Czech-Austrian transnational KPD program.
RESULTS: While the benefits of KPD programs are well established for adult recipients, recent data suggest that this may hold true also for pediatric patients. Complex algorithms, considering factors like the intricate patterns of HLA sensitization, play a pivotal role in predicting suitable matches, but for pediatric patients also non-immunological factors including age and weight match may play a role. As pool size proves crucial for program efficacy, several countries in Europe have now initiated transnational collaborations to maximize match rates. Among those, the Czech-Austrian transnational joint program, established in 2015 and now expanded to a cooperation with the Israel transplant program to further increase transplant rates, represents a successful example.
CONCLUSIONS: KPD programs, with their innovative approaches and international partnerships, hold promise for enhancing outcomes and addressing the increasing demand for kidney transplantation.
摘要：
背景：活体肾移植被认为是肾脏替代治疗的最佳选择，提供既定的利益，如优越的患者生存率和提高的生活质量。然而,免疫学挑战，包括ABO血型不相容，特别是,供体特异性HLA抗体，可能会严重影响长期结局，甚至阻止与预期供体的安全直接移植。
方法：在这篇综述中，作者讨论了肾脏配对捐赠(KPD)作为一种可行的策略,通过器官交换克服活体捐赠的免疫障碍.因此，我们特别关注捷克-奥地利跨国KPD计划。
结果：虽然KPD计划对成人接受者的好处已经确立，最近的数据表明，这可能适用于儿科患者。复杂的算法，考虑到复杂的HLA致敏模式，在预测合适的比赛中起着关键作用，但对于儿科患者，包括年龄和体重匹配在内的非免疫因素也可能起作用。由于池大小对程序效能至关重要，欧洲的几个国家现在已经开始跨国合作，以最大限度地提高匹配率。其中,捷克-奥地利跨国联合计划，成立于2015年，现在扩大到与以色列移植计划的合作，以进一步提高移植率，代表了一个成功的例子。
结论：KPD计划，凭借他们的创新方法和国际伙伴关系，有希望提高结果和满足日益增长的肾移植需求。
方法：在这篇综述中，作者讨论了肾脏配对捐赠(KPD)作为一种可行的策略,通过器官交换克服活体捐赠的免疫障碍.因此，我们特别关注捷克-奥地利跨国KPD计划。
结果：虽然KPD计划对成人接受者的好处已经确立，最近的数据表明，这可能适用于儿科患者。复杂的算法，考虑到复杂的HLA致敏模式，在预测合适的比赛中起着关键作用，但对于儿科患者，包括年龄和体重匹配在内的非免疫因素也可能起作用。由于池大小对程序效能至关重要，欧洲的几个国家现在已经开始跨国合作，以最大限度地提高匹配率。其中,捷克-奥地利跨国联合计划，成立于2015年，现在扩大到与以色列移植计划的合作，以进一步提高移植率，代表了一个成功的例子。
结论：KPD计划，凭借他们的创新方法和国际伙伴关系，有希望提高结果和满足日益增长的肾移植需求。
