TY - JOUR
T1 - Motivations and outcomes of compatible living donor–recipient pairs in paired exchange
AU - Chipman, Valerie
AU - Cooper, Matthew
AU - Thomas, Alvin G.
AU - Ronin, Matthew
AU - Lee, Brian
AU - Flechner, Stuart
AU - Leeser, David
AU - Segev, Dorry L.
AU - Mandelbrot, Didier A.
AU - Lunow-Luke, Tyler
AU - Syed, Shareef
AU - Hil, Garet
AU - Freise, Chris E.
AU - Waterman, Amy D.
AU - Roll, Garrett R.
N1 - Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID) grant numbers: T32HL007055 (Thomas) and K24AI144954 (Segev). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID) grant numbers: T32HL007055 (Thomas) and K24AI144954 (Segev). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2022/1
Y1 - 2022/1
N2 - Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan–Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p <.001), less often female (52% vs. 68%, p <.01), higher BMI (27 vs. 25 kg/m², p =.03), less frequently blood type O (36% vs. 80%, p <.001), and had higher eGFR (99 vs. 94 ml/min/1.73 m², p =.02), with a better LKDPI (median 7 vs. 22, p <.001). We observed no differences in graft failure or mortality. Compatible pairs made 280 additional transplants possible, many in highly sensitized recipients with long wait times. Compatible pair recipients derived several benefits from paired exchange, including better donor quality. Living donor pairs should receive counseling regarding all options available, including kidney paired donation. As more compatible pairs choose to enter exchange programs, consideration should be given to optimizing compatible pair and hard-to-transplant recipient outcomes.
AB - Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan–Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p <.001), less often female (52% vs. 68%, p <.01), higher BMI (27 vs. 25 kg/m², p =.03), less frequently blood type O (36% vs. 80%, p <.001), and had higher eGFR (99 vs. 94 ml/min/1.73 m², p =.02), with a better LKDPI (median 7 vs. 22, p <.001). We observed no differences in graft failure or mortality. Compatible pairs made 280 additional transplants possible, many in highly sensitized recipients with long wait times. Compatible pair recipients derived several benefits from paired exchange, including better donor quality. Living donor pairs should receive counseling regarding all options available, including kidney paired donation. As more compatible pairs choose to enter exchange programs, consideration should be given to optimizing compatible pair and hard-to-transplant recipient outcomes.
KW - Donor Selection
KW - Female
KW - Humans
KW - Kidney Transplantation
KW - Living Donors
KW - Motivation
KW - Tissue and Organ Procurement
KW - Transplant Recipients
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U2 - 10.1111/ajt.16821
DO - 10.1111/ajt.16821
M3 - Article
C2 - 34467618
AN - SCOPUS:85114703963
SN - 1600-6135
VL - 22
SP - 266
EP - 273
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -