The concept of kidney paired exchange and their success along with outcomes

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Journal of Kidney Treatment and Diagnosis is a peer-reviewed, Open Access journal focused on Clinical Nephrologypractice and related diseases.It covers several clinical areas of renal medicine, such as dialysis, transplantation, diabetes, anaemia, pharmacy nutrition and clinical aspects of kidney care.

The first paper outlining the concept of paired exchange was authored by FT Rapaport and published in 1986. The first recorded paired exchange transplants were organized in South Korea by Dr. Park beginning in 1991. For nearly a decade, only Dr. Park and his team in South Korea utilized this novel approach to facilitate transplants for incompatible donor - recipient pairs. In 1999, the first KPD transplants were performed in Europe followed by the first KPD transplants in the United States in 2000. Over the next ten years the United States would become the most competitive KPD market in the world with more than a dozen KPD programs commencing operations and many KPD programs failing. Outside of the United States, most of the KPD programs have been organized or sponsored by governments which has limited innovation in these programs. Three of the important early KPD programs in the U.S. were the Hopkins program led by Dr. Montgomery and Dr. Segev, the New England Paired Kidney Exchange (NEPKE) led by Dr. Delmonico and Professor Alvin Roth and the Ohio Organ Consortium which later reorganized as two competing programs, the Paired Donation Network (PDN) led by Dr. Woodle and the Alliance for Paired Exchange (APD) led by Dr. Rees.

The Hopkins program, which was based out of the Johns Hopkins Hospital, led the industry in early innovations including the critical "Domino Chain" breakthrough which allowed Good Samaritan donors to start chains, dramatically increasing the number of pairs that could be matched in a swap compared to the loop approach that was used previously. Once the Hopkins team began organizing Domino Chains, these swaps became larger and began attracting national media attention due to the massive complexity and significant impact of these large swaps. Unlike the Hopkins program that was hospital based, NEPKE was launched within the New England Organ Procurement Organization which served several states in the North East. The PDN and APD organizations were founded by transplant surgeons but attempted to create networks of transplant centers that would work together to pool their incompatible pairs, much like NEPKE but without OPO support.

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With Regards,
John Robert                              
Managing Editor
Journal of Kidney Treatment and Diagnosis