Comparison of domino transplantation with Two-Way Paired Exchange and normal transplantation: acute rejection, surgical complications, and 5-year survival outcomes.
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引用次数: 0
Abstract
Background: Domino kidney paired donation and Two-Way Paired Exchange have emerged as vital strategies to expand the donor pool in renal transplantation, especially for patients facing ABO or HLA incompatibilities. Despite their potential benefits, concerns remain regarding immunological risks, infectious complications, and long-term graft survival.
Methods: In this retrospective cohort study conducted at Medicana Transplant Center, 980 adult kidney transplant recipients were categorized into three groups: Domino (n = 144), Two-Way Paired Exchange (n = 350), and Normal Transplant (n = 486). Baseline characteristics, acute rejection rates, and surgical or infectious complications were collected, alongside data on 1-year and 5-year patient and graft survival. Statistical analysis included Kaplan-Meier survival curves and Cox proportional hazards modeling for independent predictors of graft outcomes.
Results: The Domino group had the highest 1-year acute rejection rate (17.4%) compared to Two-Way Paired Exchange (4.3%) and Normal Transplant (3.7%), yet 1-year graft survival rates remained comparable (92%, 95%, and 96%, respectively; p = 0.271). Infectious complications were more frequent in the Domino group (25%) than in others (p < 0.01). Extended follow-up to 5 years indicated no statistically significant difference in overall graft or patient survival among the three groups (log-rank p = 0.197), despite a trend toward lower 5-year graft survival in the Domino group. Donor-specific antibodies and higher HLA mismatches independently predicted acute rejection.
Conclusions: Domino transplantation, while associated with higher immunologic challenges, achieves acceptable short-term and 5-year outcomes akin to Two-Way Paired Exchange and Normal Transplant. Careful immunosuppressive strategies, vigilant monitoring, and collaborative protocols are integral for optimizing long-term success in high-risk transplant scenarios.
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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