Pilot Kidney Exchange Between U.S. and Italy Will Save Lives

The Alliance for Paired Kidney Donation (APKD), an Ohio-based, non-profit organization managing an international kidney exchange registry, has launched a pilot kidney exchange transplant program between the United States and Italy. 

According to the Centers for Disease Control and Prevention, more than 10 percent of American adults – about 20 million people — have chronic kidney disease. When a person's kidneys fail, their body can't clear wastes and extra water. The result is the individual will require kidney dialysis or a kidney transplant are the only options.

Nearly 786,000 people in the United States are living with end-stage renal disease. Of those people, 71% are on dialysis, and 29% with a kidney transplant. A record 23,401 U.S. kidney transplants were performed in 2019, but more than 90,000 people remained on a waitlist. Nationally, 17 people die each day awaiting a compatible kidney. 

The signing of the agreement between APKD and Centro Nazionali Trapianti (CNT), the organization which manages all transplantation activity in Italy, allows for the first-ever exchange of living donor kidneys between Europe and the United States.

Michael A. Rees, MD, Ph.D., the CEO of APKD and Massimo Cardillo the director of the CNT at the ceremony signing the agreement.

Increasing Number of Living Kidney Transplants

APKD believes collaboration between its organization and CNT could significantly increase the number of living donor kidney transplants achieved for both Italian and U.S. citizens with kidney failure.

The goal of the memorandum of understanding, signed at the Ministry of Health in Rome, is to provide for the possible treatment of thousands of patients awaiting kidney transplants in both the U.S. and Italy. The agreement was signed on behalf of CNT by its director, Massimo Cardillo, and by Michael A. Rees, MD, Ph.D., the CEO of APKD, and the surgical director of kidney transplantation at the University of Toledo Medical Center in Ohio.

The new US-Italy program concerns kidney exchange transplantation, in which incompatible living donor and recipient pairs are matched with other incompatible pairs for kidney transplants. 

Thanks to the agreement between APKD and CNT, incompatible American and Italian donor-recipient pairs will be able to exchange with each other based on a shared algorithm that will verify the level of compatibility between those on the countries' transplant waiting lists. 

In this way, patients with kidney failure who have an incompatible volunteer donor will have a greater chance of receiving the transplant they need.

In addition to the technical-operational aspects – such as the requirements of the participating hospitals, matching algorithm, and overall governance of the transplant process – the agreement provides that the costs related to the transplant procedure are borne by the U.S. insurance coverage for the U.S. recipient and the Italian donor. At the same time, the Italian National Health Service will cover the expenses for the Italian recipient and the American donor. Transplant surgeries will take place in the country where the recipient is located.

Need for Kidney Care

There is a surging need for kidneys in the United States and worldwide. Why is there such a need for kidneys? Donald C. Dafoe, MD, professor and chief of transplantation and surgical director of the University of California, Irvine's UCI Health Kidney Transplant Services, says there are several factors involved in these numbers.

People are living longer and we are seeing increasing rates of obesity, diabetes and hypertension, which leads to higher rates of chronic kidney disease and more patients in need of dialysis. At UCI, we have more than 700 people with end-stage kidney disease on our wait list.

The agreement with Italy is the latest example of APKD's global leadership in the field of kidney exchange. In late 2021, the organization also helped coordinate a historic series of kidney transplants between donors and patients in Israel and the United Arab Emirates that saved the lives of three women.

Today in the U.S., about 20% of the 6,000 living donor kidney transplants performed are achieved through kidney exchange. APKD believes collaboration between its organization and CNT could significantly increase the number of living donor kidney transplants achieved for both Italian and U.S. citizens with kidney failure.

Rees says that the kidney exchange helps celebrate our differences – for the benefits they enable. 

Larger pools offer more opportunities for kidney exchange for the incompatible pairs in those pools. But an often-overlooked aspect of kidney exchange is that patients with antibodies that prevent their donors from donating are often produced against targets that are common within their ethnicity or population. Kidney exchange shows us how our differences can be the critical component, allowing us to help one another by providing donors that lack the targets of such antibodies.

The director of the CNT, Massimo Cardillo, says living kidney transplants are an effective therapeutic option for recipients and absolutely safe for donors. However, in Italy, they represent less than 17% of kidney transplants that are performed yearly.

This is a rapidly growing percentage but still insufficient to respond to the many patients still waiting. This agreement between Italy and the U.S. literally opens a new frontier and will allow us to significantly increase the chances of establishing positive matches between different patients.

Kidney Transplants Mean Better Quality of Life

UIC’s Dr. Dafoe says kidney transplants are not just about longevity.

We're also greatly improving the patient's quality of life. Transplant patients have more freedom in terms of diet and even travel now that they aren't spending hours in dialysis three or four times a week. They also have more energy and think more clearly.

Adults Should Be Screened for Kidney Disease

The National Kidney Foundation (NKF) recommends adults over 60 get screened for kidney disease. NKF advises annual screening with a simple urine albumin test that checks for protein in the urine- the earliest sign of kidney damage- and a blood test for kidney function.

National Kidney Foundation President Dr. Beth Piraino says we lose kidney function as we age.

Many people don't realize that, as we age, we lose kidney function. Unfortunately, older Americans may not realize they are at increased risk until it is too late.

While chronic kidney disease is irreversible, lifestyle changes and medications can help relieve the symptoms and stop them from worsening - controlling symptoms and slowing progression.