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Article

Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations

by
Taihei Ito
1,*,
Miki Ito
1,
Naohiro Aida
1,
Kei Kurihara
1,
Akihiro Terao
1,
Yoshihiko Watarai
2,
Mitsuru Saito
3,
Keizo Kaku
4,
Daisuke Ishii
5,
Satoshi Sekiguchi
6,
Tatsuo Yoneda
7,
Kohei Unagami
8,
Masayuki Tasaki
9,
Hitoshi Iwamoto
10,
Motoo Araki
11,
Kazuhiro Takahashi
12,
Kazuaki Yamanaka
13,
Mikio Sugimoto
14,
Kouhei Nishikawa
15,
Chikashi Seto
16,
Masaki Muramatsu
17,
Toshihiro Asai
18,
Daiki Iwami
19,
Yasutoshi Yamada
20,
Shigeyoshi Yamanaga
21,
Tomonori Komatsu
22,
Masayoshi Miura
23,
Takahiro Nohara
24,
Michihiro Maruyama
25,
Yuki Miyauchi
26,
Toshiaki Tanaka
27,
Michio Nakamura
28,
Kiyohiko Hotta
29 and
Takashi Kenmochi
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1
Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Dengakugakubo 1-98, Kutsukakecho, Toyoake 470-1192, Japan
2
Department of Transplant Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi 466-8650, Japan
3
Division of Blood Purification, Akita University Hospital, Akita 010-8543, Japan
4
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
5
Department of Urology, Kitasato University of Medicine, Kanagawa 252-0375, Japan
6
Transplantation Surgery, Japan Community Healthcare Organization Sendai Hospital, Miyagi 981-3281, Japan
7
Unit of Dialysis, Department of Urology, Nara Medical University, Nara 634-8522, Japan
8
Organ Transplant Medicine, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
9
Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
10
Department of Kidney Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo 193-0998, Japan
11
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
12
Department of Gastrointestinal and Hepatobiliary Pancreatic Surgery, University of Tsukuba, Ibaraki 305-8575, Japan
13
Department of Urology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
14
Department of Urology, Faculty of Medicine, Adrenal Surgery and Renal transplantation, Kagawa University, Kagawa 761-0793, Japan
15
Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie 514-8507, Japan
16
Department of Urology, Toyama Prefectural Central Hospital, Toyama 930-0194, Japan
17
Department of Nephrology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan
18
Department of Kidney Transplant and Dialysis, Osaka City General Hospital, Osaka 534-0021, Japan
19
Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Tochigi, 329-0498, Japan
20
Department of Blood Purification, Kagoshima University Hospital, Kagoshima, 890-8520, Japan
21
Department of Transplant Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8502, Japan
22
Department of Urology, Chukyo Hospital, Japan Community Healthcare Organization, Aichi 457-8510, Japan
23
Department of Renal Transplantation Surgery and Urology, Sapporo Hokuyu Hospital, Hokkaido 003-0006, Japan
24
Department of Urology, Kanazawa University Hospital, Kanazawa 920-8641, Japan
25
Department of Frontier Surgery, Chiba University School of Medicine, Chiba 260-8670, Japan
26
Department of Urology, Ehime university, Ehime 791-0295, Japan
27
Department of Urology, Sapporo Medical University, Hokkaido 060-8543, Japan
28
Department of Transplant Surgery, Tokai University School of Medicine, Kanagawa 259-1193, Japan
29
Department of Renal and Genitourinary surgery, Faculty of Medicine, Hokkaido University, Hokkaido 060-8648, Japan
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 6122; https://doi.org/10.3390/jcm14176122 (registering DOI)
Submission received: 2 July 2025 / Revised: 22 August 2025 / Accepted: 28 August 2025 / Published: 29 August 2025
(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)
Versions Notes

Abstract

Objectives: To clarify the need for a kidney exchange program (KEP) in Japan by conducting a questionnaire survey on KEPs and simulated KEPs by virtual cross-matching based on past cases of transplantation avoidance. Methods: In addition to the content regarding KEPs, an electronic survey was conducted to investigate the number of cases of kidney transplant abandonment due to “immunological” reasons over the past 10 years (2012–2021). Virtual cross-matching was conducted to simulate the feasibility of avoiding immunological risks and enabling kidney transplantation in patients who were previously unable to undergo the procedure. Results: The survey received responses from 107 facilities (response rate: 81.7%). In response to the question about the necessity of a KEP in Japan, 71 facilities (66.4%) indicated that KEPs are necessary. In addition, 251 living-donor kidney transplants were abandoned for “immunological” reasons over the past decade (2012–2021). Among the 80 pairs for which detailed information was available, virtual cross-matching simulations showed that 37/80 pairs (46.3%) were donor-specific antibody (DSA)-negative for blood type-matched combinations, and 41/80 pairs (51.3%) were DSA-negative for blood type-incompatible transplants. Conclusions: The need for a KEP in Japan and its potential usefulness were demonstrated.
Keywords: kidney transplantation; donor-specific antibodies; kidney exchange program; virtual cross-matching kidney transplantation; donor-specific antibodies; kidney exchange program; virtual cross-matching

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MDPI and ACS Style

Ito, T.; Ito, M.; Aida, N.; Kurihara, K.; Terao, A.; Watarai, Y.; Saito, M.; Kaku, K.; Ishii, D.; Sekiguchi, S.; et al. Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations. J. Clin. Med. 2025, 14, 6122. https://doi.org/10.3390/jcm14176122

AMA Style

Ito T, Ito M, Aida N, Kurihara K, Terao A, Watarai Y, Saito M, Kaku K, Ishii D, Sekiguchi S, et al. Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations. Journal of Clinical Medicine. 2025; 14(17):6122. https://doi.org/10.3390/jcm14176122

Chicago/Turabian Style

Ito, Taihei, Miki Ito, Naohiro Aida, Kei Kurihara, Akihiro Terao, Yoshihiko Watarai, Mitsuru Saito, Keizo Kaku, Daisuke Ishii, Satoshi Sekiguchi, and et al. 2025. "Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations" Journal of Clinical Medicine 14, no. 17: 6122. https://doi.org/10.3390/jcm14176122

APA Style

Ito, T., Ito, M., Aida, N., Kurihara, K., Terao, A., Watarai, Y., Saito, M., Kaku, K., Ishii, D., Sekiguchi, S., Yoneda, T., Unagami, K., Tasaki, M., Iwamoto, H., Araki, M., Takahashi, K., Yamanaka, K., Sugimoto, M., Nishikawa, K., ... Kenmochi, T. (2025). Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations. Journal of Clinical Medicine, 14(17), 6122. https://doi.org/10.3390/jcm14176122

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