Exchange living-donor kidney transplantation: Merits and limitations

Kyu Ha Huh, Myoung Soo Kim, Man Ki Ju, Hye Kyung Chang, Hyung Joon Ahn, Su Hyung Lee, Jong Hoon Lee, Soon Il Kim, Yu Seun Kim, Kiil Park

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Background.: The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce. Methods.: From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program. Results.: The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007). Conclusion.: We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients.

Original languageEnglish
Pages (from-to)430-435
Number of pages6
Issue number3
Publication statusPublished - 2008 Aug 15

All Science Journal Classification (ASJC) codes

  • Transplantation


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