[10, 11, 18, 19] Death with functioning graft due to infections is the most common cause of death in these patients which remain a major challenge in developing countries due to poor social economic and environmental conditions. We have performed 56 additional LDKTx in one year in our single centre with our KPD program in year 2013. We have the largest single-centre report

from India.[11] We reported 10 simultaneous KPD transplantations in a single day in a single centre on World Kidney day raising awareness of KPD.[11] In our experience a detailed pre-operative donor evaluation should be done in order to obtain equivalent pairs from an anatomic, functional and immunological standpoint. Despite legislative permission from the Transplantation of Human Organs Act 2011 amendments to perform KPD, one of the most challenging barriers Target Selective Inhibitor Library nmr is the time required for permission from different PLX4032 research buy state government authorization committees. The limitation is not a willingness to participate in KPD, but rather barriers to its execution. To increase access to KTx, nephrologists in Mumbai set up the Apex

Swap Transplant Registry to facilitate KPD. In the 30 months since its inception the registry has facilitated 27 such swaps. Apex Swap Transplant registry successfully performed five simultaneous KPD transplants for the first time in India in June 2013.[13] This was a result of about 2 years of hard work and the second attempt. The first attempt resulted in failure and collapse of the chain due to the death of a patient due to delays in getting the permissions, which did not come through even after 9 months. We hope that this successful operation opens a new door to many more such dominoes across the country giving an opportunity to improve transplant outcome. At our centre we favour two-way exchanges over longer chains to minimize the number of discontinuations that would result if one patient becomes medically unfit for KTx and minimizing

Carnitine palmitoyltransferase II the number of simultaneous transplants. Between 2006 and 2011, a single centre in North India performed 44 living KPD KTx. ABO incompatibility or positive lymphocyte cross-match were found in 20 pairs and two pairs, respectively. The graft survival rate was 100% with a median serum creatinine level of 1.35 mg/dL at 3 years and one patient died after 4 month of transplant due to sepsis.[14] Between 2008 and 2011, 14 KPD and, 26 ABO-I using conventional splenectomy and seven ABO-I using rituximab were carried out in Mumbai. The graft survival and patient survival 12–18 months after transplant were 78.9%:80% for ABOi with splenectomy, 85.7%:85.7% for ABOi without splenectomy and 100%:100% for KPD.[12] We believe that cost and risk of infection are important factors needed to be considered in a developing country like ours while deciding between KPD and ABO-incompatible KTx.