September 25, 2022

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Signing of a kidney donation agreement between Italy and the United States

Rome, 8 September. (Adnkronos Salute) – A new possibility of treatment for nearly 6,000 patients waiting for a kidney transplant: this is the aim of the Memorandum of Understanding to launch a pilot program for cross-way kidney donation between Italy and the United States signed today at the Ministry of Health. The agreement was signed by the National Center for Organ Transplantation (CNT), represented by Director Massimo Cardillo, and by the Alliance for Double Kidney Donation (Apkd), a non-profit organization that operates one of the live kidney transplant programs in the USA, represented by its President Michael A. . Reese, MD, director of the Kidney Transplant Center at the University of Toledo Medical Center, Ohio.

In all, 2043 kidney transplants were performed in Italy in 2021, of which 341 were from living donors: 5 were performed through exchange between donors and recipients. At the signing of the protocol were present under Secretary of Health Pierpaolo Celeri and Ignacio Marino, executive director of the Jefferson Center Italy, the organization that promotes health collaboration initiatives between Thomas Jefferson University in Philadelphia and Italian institutions.

“Currently, about 30% of live kidney transplants are made impossible due to incompatibility between donor and recipient – with today’s agreement, although currently in the experimental phase, the search for donor-recipient pairs who are mutually compatible is extending to numerically consistent,” Sileri said. and genetically heterogeneous as the US, which increases the likelihood of identifying compatible donors for those difficult-to-transplant patients who will be assigned to lifelong dialysis.It is a starting point and I hope that this pilot project can be expanded in the future to give more options for those who unfortunately do not have any of it today.”

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The new program between Italy and the United States concerns the so-called “cross” kidney transplants, that is, those that are carried out through a mutual “exchange” of an organ between spouses where the donor is not genetically compatible with its recipient, but is compatible with the recipients of another couple. Thanks to the agreement between Cnt and Apkd, pairs of Italian and American patients will be able to cross each other based on a common algorithm that will check the level of compatibility between those enrolled in the two waiting lists: in this way, patients with chronic renal failure who have an unsuitable volunteer donor will have a greater chance To receive the transplant they need.

In addition to the technical and operational aspects (requirements of participating hospitals, matching algorithm, overall governance of activities), the agreement states that costs related to the transplant procedure are borne by the US patient insurance coverage and for US patients. Italian donor. The Italian National Health Service will cover the expenses of the Italian patient and the American donor. The donors will travel: the removal and subsequent kidney transplantation will actually happen in the recipient’s country. The pilot phase will concern the first three cases and will be limited to three hospitals: for Italy, the Kidney Transplant Center at Gemelli Hospital in Rome, managed by Franco Citterio, who was present at the signing of the agreement, while for the USA, the University of Toledo Medical Center and University Hospital Columns will participate. Thomas Jefferson in Philadelphia. Once the operational and management trials are completed, the program will be re-evaluated for possible standardization of the protocol and gradual expansion to other live kidney transplant centers of the Italian network.

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The agreement with the United States is the second international exchange protocol to be activated by our country: since 2018, an agreement has entered into force between France, Portugal and Spain that has resulted in three cross transplants with precisely the latter country. From 2015 to date, the Italian National Kidney Transplant Program has allowed 77 interventions to be performed.

“Live kidney transplants are an effective treatment option for recipients and are completely safe for donors, but so far account for less than 17% of kidney transplants performed annually in Italy – Cardillo commented – this is a percentage in strong growth, but it is still not enough to respond On the many patients who are still waiting. This agreement between Italy and the United States really opens up new frontiers and will allow us to significantly increase the chances of establishing a positive match between different patients.” The ultimate goal, added the head of Cnt, is an international network of organ transplants: “Based on this experience, we will be able to work towards a cooperation agreement between all European countries that will allow us to internationalize mutual donation programs in order to benefit patients.”

“In the United States, about 20% of 6000 live kidney transplants are performed thanks to exchanges. We believe that this collaboration between Cnt and Apkd will greatly increase the chances for both Italian and American patients with renal insufficiency,” highlights Reese. “Kidney exchange, he notes, shows us how valuable and resource differences can be: Expanding the pool of donors to benefit from increases the chances of transplantation, because genetic incompatibility is more easily recorded among racially homogeneous people. It will give the American population greater opportunities to find compatible donors to Italian patients from what is happening today at the crossings with the citizens of southern Europe. ”

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