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CROSS KIDNEY TRANSPLANTATION


It is the realization of kidney transplantation by matching pairs not receiving kidney from their own donors in the cases that kidney transplant can’t be performed by the recipient and donor in living donor kidney transplantations due to blood group incompatibility. 

Kidney transplantation is possible for the patients that kidney transplantation is not possible although they have donors without the compatibility of blood group by a procedure called as “cross transplantation (exchange transplantation, kidney fraternity, paired donation)”. Donor donates his kidney to another patient he doesn’t know and retrieves his relative from the expectation of calling by cadaver list and also a number of health problems led by renal failure including end of life due to extension of this expectation.

To perform the cross transplantation, transplantation candidate person having a living donor but blood group incompatibility between them is in question should apply to transplantation centers with his donor. Cross transplantation process requires a perfect coordination and serious investigation. Patient and his family should notify the cross transplantation request to the transplantation center. Data of patients are matched at kidney transplantation centers by use of patient lists having cross transplantation requests. Eligible pairs are informed and invited for meeting and families are introduced.  If both families consent, health condition of the persons will be examined and transplantation process will be initiated. Operations of both donors start at the same time in cross transplantation and kidneys are excised simultaneously and operations of recipients begin at the same time and transplantation is performed on the same day. This method can be applied to more than 2 pairs if compatible pairs are found.

Matching Recipient and Donor
Blood group A or B patients can be the candidate of cross transplantations if there is no donor with compatible blood group. Patient not receiving kidney from his relative due to blood and tissue incompatibility although he has a volunteer relative donor is matched to the person with the same condition and kidney is transplanted from the donor of the one to the recipient of the other and this is the cross transplantation.

Let’s suppose that a transplantation candidate patient blood group of who is A (recipient A) has a donor relative with blood group B (donor A). In another family, there is a blood group A donor (donor B) and blood group B recipient (recipient B). Since blood compatibility is not applicable for the relatives of both families, kidney can’t be transplanted from the relatives. In addition to this, the blood group B health patient’s relative (donor A) can donate his kidney to blood group B (recipient B) dialysis patient by means of cross transplantation procedure.  Donating kidneys of two different family members to each other can be called as “kidney fraternity”. 

Kidney fraternity is a significant option not only for solving ABO blood group incompatibility but also achieving transplantation between pairs not being eligible for cross-examination. In this case, all criteria including blood groups of recipient and donor for the transplantation are good but the result is positive for cross-match examination and the transplantation will not be possible. In this case,  if cross-match examination for two similar pairs is negative, both patients can get healthy again by means of cross transplantation.

Works on cross transplantation are considered more significant in the world to increase tissue compatibility between the recipient and donor more. Cross kidney transplantation realized in Korea for the first time has become widespread in time. Fast increase of this method will increase the kidney transplantation teams and reduce the kidney waiting list and enable the chronic renal failure patients going into dialysis get healthy earlier. The significance of cross transplantation will be understood if we consider that most of patients waiting for kidney transplantation die before the transplantation.