Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 16;9(11):e1549.
doi: 10.1097/TXD.0000000000001549. eCollection 2023 Nov.

Scandiatransplant Exchange Program (STEP): Development and Results From an International Kidney Exchange Program

Ilse Duus Weinreich  1 , Tommy Andersson  2 , Margrét Birna Andrésdóttir  3 , Mats Bengtsson  4 , Alireza Biglarnia  5 , Claus Bistrup  6 , Line Boulland  7 , Helle Bruunsgaard  8 , Ilkka Helanterä  9 , Kulli Kölvald  10 , Jouni Lauronen  11 , Jørn Petter Lindahl  12 , Karin Skov  13 , Søren Schwarz Sørensen  14 , Lars Wennberg  15 , Per Lindner  16
Affiliations

Scandiatransplant Exchange Program (STEP): Development and Results From an International Kidney Exchange Program

Ilse Duus Weinreich et al. Transplant Direct. .

Abstract

Background: Kidney transplant candidates may be incompatible with their intended living donors because of the presence of antibodies against HLA and/or ABO. To increase the possibility of finding an acceptable kidney donor for these patients, the Scandiatransplant Exchange Program (STEP) program within Scandiatransplant was launched in 2019.

Methods: This is a retrospective review of our experiences from the first 4 y of the STEP program, including details about the match runs, performed transplantations, and recipient outcomes within the program.

Results: During 2019-2022, 11 match runs and 4 reruns were performed. In total, 114 pairs and 6 anonymous donors participated in these match runs. Fifty-one pairs (45%) participated in 1 match run, 31 pairs (27%) participated in 2 match runs, and 32 pairs (29%) participated in ≥3 match runs. Seventy-two individuals (63%) participated because of HLA incompatibility, 19 (17%) because of ABO incompatibility, and 7 (6%) because of both HLA and ABO incompatibility.Forty percent of the patients enrolled in the program underwent transplantation. In total, 49 transplantations have so far been performed within the program, and 46 (94%) of the recipients had a functioning kidney graft at follow-up in February 2023.

Conclusions: The STEP program offers sensitized patients an enlarged pool of living donors and a chance of a compatible international living donor, resulting in an increased number of total transplantations. Currently, STEP is one of the largest transnational kidney exchange programs and has improved the situation for patients waiting for kidney transplantation in Scandiatransplant.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Distribution in each match run of new pairs (new) and pairs included in several match runs (repeated).
FIGURE 2.
FIGURE 2.
Status at the end of the year 2022 of all donor–recipient pairs included in STEP. STEP, Scandiatransplant Exchange Program; Tx, transplant.
FIGURE 3.
FIGURE 3.
The distribution of transplantations per year and country and out of these the number of kidneys exchanged between countries.
FIGURE 4.
FIGURE 4.
Kaplan-Meier curve comparing graft survival of recipients transplanted with kidneys from LDs through STEP and outside STEP (LD). LD, living donor; STEP, Scandiatransplant Exchange Program.
FIGURE 5.
FIGURE 5.
Recipient creatinine values posttransplantation. AMR, antibody-mediated rejection.
See this image and copyright information in PMC

References

    1. Hariharan S, Israni AK, Danovitch G. Long-term survival after kidney transplantation. N Engl J Med. 2021;385:729–743. - PubMed
    1. Segev DL, Gentry SE, Warren DS, et al. Kidney paired donation and optimizing the use of live donor organs. JAMA. 2005;293:1883–1890. - PubMed
    1. Biro P, Haase-Kromwijk B, Andersson T, et al. ; ENCKEP COST Action. Building kidney exchange programmes in Europe—an overview of exchange practice and activities. Transplantation. 2019;103:1514–1522. - PMC - PubMed
    1. Ferrari P, Weimar W, Johnson RJ, et al. Kidney paired donation: principles, protocols and programs. Nephrol Dial Transplant. 2015;30:1276–1285. - PubMed
    1. Weinreich I, Bengtsson M, Lauronen J, et al. Scandiatransplant acceptable mismatch program—10 years with an effective strategy for transplanting highly sensitized patients. Am J Transplant. 2022;22:2869–2879. - PMC - PubMed