First 100 cross-over kidney transplants performed in Spain, now becomes standard practice in the country

Spain recently performed its 100th cross-over kidney transplant, the acceptance of which in society is increasing every day. According to data from the ONT, a total of 101 cross-over kidney transplants had been performed in Spain at 1 October 2014, 35 of them this year.

54 of the transplant recipients were women and 47 were men.

This type of transplant has increased five-fold in the last four years and now accounts for 11% of all live-donor kidney transplants.

In Spain, the most recent cross-over kidney transplant was performed at the end of September and comprised an exchange between three donor-recipient couples undergoing surgery in Malaga and Zaragoza.

A few days earlier, a transplant chain involving a 'good samaritan' donor had taken place during a complicated process that involved medical teams, donors and recipients from Murcia, Andalusia and Catalonia.

Spain is also seeing an increase in the number of effective 'good samaritan' donors. To date, this type of donor has enabled five cross-over kidney transplant chains to be initiated, involving a total of 17 transplant recipients.

Living-donor kidney transplantation

Cross-over kidney transplants basically comprise an exchange of live kidney donors between two or more donor-recipient couples. The goal is to offer patients with chronic renal failure the chance to receive an organ from a living donor, even when their partner or family members are incompatible. This is a highly developed form of treatment in countries with a high living-donor kidney transplantation rate. This is the case in South Korea, the Netherlands, the United Kingdom, Australia, Canada and the United States, where this type of transplant has been performed for over a decade with excellent results.

The use of increasingly less invasive surgical techniques and the study and care of donors (before, during and after the operation) have enabled this type of transplant to become more common, given that the possible complications for the donor have been reduced considerably and kidney extraction from live donors is now considered a low-risk procedure.

This type of transplant involves a complicated logistics process that requires full cooperation between the central ONT office, the regional transplant coordinators, the hospitals and the medical teams taking part in the operation.

The first cross-over kidney transplant in Spain was performed in July 2009. For this milestone to be achieved, the ONT first worked with a multidisciplinary task force on developing a joint protocol that carefully examines every aspect of a cross-over live kidney transplant.

Register of donor-recipient couples

One fundamental aspect of this programme is the National Register of Donor-Recipient Couples and a computer application that enables possible exchanges between couples on the register to be quickly identified. It should be noted that those patients who register with this programme still remain on the waiting list for a deceased donor.

Since 2009, a total of 340 patients and their respective donors have been registered on this system at one time or another. 114 of those were active at 1 October, which means that possible combinations involving the various couples are currently being assessed. This latest crossover will enable the number of transplants to be increased by the end of the year.

23 hospitals throughout Spain and 16 histocompatibility laboratories are involved in the cross-over kidney transplant programme.

Ranking by hospital

The top hospitals in terms of the number of cross-over kidney transplants performed are as follows: Fundación Puigvert in Barcelona (17); Hospital Clínic i Provincial in Barcelona (15); Hospital Carlos Haya in Malaga (11); Hospital de Cruces in Bilbao ( 9); and Hospital Puerta del Mar in Cadiz (9).

The cross-over kidney transplant is one of the living-donor kidney transplantation methods being promoted by the ONT as part of its Donation 40 strategic plan.

Last year, 382 live-donor kidney transplants were performed in Spain, representing 15% of the total target set by the Spanish National Transplant Organisation.