Living donor kidney transplant: 6 patients operated on at the same time, a first in France - Press release

Cross-donation makes it possible to circumvent incompatibility (of blood group and/or immunological type) between a living kidney donor and his or her sick loved one, by bringing together "pairs" of donors/recipients who are not compatible with each other, but whose recipient is compatible with the donor of the other pair - and vice versa.

The new law on bioethics promulgated on August 2, 2021 has changed the terms and conditions of this type of donation, and the number of donor-recipient pairs authorized in cross-kidney donation has been increased from two to six, making it possible to increase matching possibilities and improve access to living-donor transplantation for the thousands of patients with chronic end-stage renal disease (CTRD).

Every month, the Agence de la biomédecine searches for possible matches between patients waiting for a kidney transplant and a relative who is incompatible but willing to donate, and who are registered with the program. The greater the number of donor-recipient pairs registered, the greater the chances of identifying compatible pairs at national level. When two or more pairs can be cross-donated, the medical teams concerned are contacted by the Agency to validate the project and carry out the final compatibility tests. This final test verifies that there are no incompatibilities between the pairs obtained by cross-donation.

The Agence de la biomédecine has organized the first triplet of cross-donations between three pairs of donors and recipients, with the Reims and Bordeaux university hospitals.

The Agence de la biomédecine guarantees anonymity between the pairs, including with the medical-surgical teams. Recipients can never know from whom they received their kidney, nor can donors know to whom their kidney was transplanted.

The Agence de la biomédecine coordinates this complex process. First of all, it deploys the mathematical algorithms used to find blood and immunological matches between donors and recipients on the basis of registered pairs. It then puts the hospital teams of the patients concerned in touch, and facilitates the transfer of medical data by anonymizing them and securing exchanges. It then helps to synchronize surgical procedures between the various health establishments, alongside the hospital teams, and finally coordinates the transport of the transplants, with the aim of minimizing the duration of cold ischemia, and thus preserving the quality of the transplanted kidneys.

In all, six linked operations were carried out within the maximum 24-hour period laid down by law.

For several years now, Reims University Hospital has been committed to developing kidney transplants using living donors. In 2022, the hospital carried out its first cross-donor transplant, which was also the first in France in the last five years. While organ transplantation is a complex operation, the simultaneous transplantation of three kidneys represents a considerable organizational and medical challenge. This feat testifies to the exceptional expertise and coordination of the medical and nursing teams at the two university hospitals, under the aegis of the French Biomedicine Agency (Agence de la biomédecine).

Thanks to a multi-disciplinary team, the nephrology transplantation dialysis apheresis department at Bordeaux University Hospital aims to provide optimal care for patients undergoing kidney transplantation. It is with an unwavering commitment to medical excellence that its medical and surgical teams participate in the cross-donation program. Bordeaux University Hospital is proud to have contributed to this first in France.

A second triplet is currently being organized, and will take place by the end of 2024. The use of this type of program seems to be finally taking off in France, with many pairs in the test phase. Active participation by professional teams is essential to achieve a sufficient number of pairs to facilitate pairings. In the UK, over a hundred kidney transplants are carried out each year using cross-donation, and the number of incompatible transplants is very limited.

• Scheduling the transplant allows the recipient to be better prepared, both medically and psychologically, for the surgical procedure.
• The graft is of better quality, because the time interval between harvesting and transplantation, known as the "cold ischemia time", is shorter, and the blood and immunological compatibility between donor and recipient is better.
• Transplants from living donors work better and longer than those from deceased donors. Ten years after transplantation, the survival rate for grafts from living donors is 76.3%, compared with 61.4% for grafts from deceased donors.
• Reduced risk of rejection of the transplanted organ, and of complications linked to heavier anti-rejection treatments, particularly when an incompatible transplant is proposed.
• Controlled risks for the donor, particularly during the perioperative phase. Serious post-operative complications requiring re-hospitalization and/or re-operation are rare, estimated to occur in between 1% and 3% of cases.

Kidney harvesting does not reduce donor life expectancy.