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Multicenter Study
. 2018 Jun;18(6):1510-1517.
doi: 10.1111/ajt.14689. Epub 2018 Mar 9.

Kidney exchange match rates in a large multicenter clearinghouse

Courtenay M Holscher  1 , Kyle Jackson  1 , Eric K H Chow  1 , Alvin G Thomas  1 , Christine E Haugen  1 , Sandra R DiBrito  1 , Carlin Purcell  2 , Matthew Ronin  2 , Amy D Waterman  3   4 , Jacqueline Garonzik Wang  1 , Allan B Massie  1   5 , Sommer E Gentry  1   6 , Dorry L Segev  1   5
Affiliations
Multicenter Study

Kidney exchange match rates in a large multicenter clearinghouse

Courtenay M Holscher et al. Am J Transplant. 2018 Jun.

Abstract

Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while experiencing the morbidity of dialysis. The balance between waiting for KPD vs desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multicenter KPD clearinghouse, between October 2011 and September 2015 using a competing-risk framework. Among 1894 candidates, 52% were male, median age was 50 years, 66% were white, 59% had blood type O, 42% had panel reactive antibody (PRA)>80, and 50% obtained KPD through NKR. Median times to KPD ranged from 2 months for candidates with ABO-A and PRA 0, to over a year for candidates with ABO-O or PRA 98+. Candidates with PRA 80-97 and 98+ were 23% (95% confidence interval , 6%-37%) and 83% (78%-87%) less likely to be matched than PRA 0 candidates. ABO-O candidates were 67% (61%-73%) less likely to be matched than ABO-A candidates. Candidates with ABO-B or ABO-O donors were 31% (10%-56%) and 118% (82%-162%) more likely to match than those with ABO-A donors. Providers should counsel candidates about realistic, individualized expectations for KPD, especially in the context of their alternative treatment options.

Keywords: ABO incompatibility; clinical research/practice; donors and donation; donors and donation: paired exchange; health services and outcomes research; kidney transplantation/nephrology; kidney transplantation: living donor; panel reactive antibody (PRA).

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Candidate registry removal reasons
Figure 2
Figure 2. Stacked Plot of NKR Registrant Candidate Outcomes
Other includes: other, unknown, and unavailable donor; Other LDKT includes other KPD and found compatible donor; Died includes too sick. The numbers in the graph represent the percentage of registrants who experienced that outcome at that time. For example, at 1 year, 46% of registrants were matched into an NKR KPD, and 9.2% received another LDKT, etc.
Figure 3
Figure 3. Cumulative Incidence and Median Time to KPD in NKR by Candidate ABO Type and PRA
Median times to KPD, in months, and number of KPDs are shown within each cumulative incidence curve pane.
Figure 4
Figure 4. Cumulative Incidence and Median Time to KPD in NKR by Paired Donor ABO Type and Candidate PRA
Median times to KPD, in months, and number of KPDs are shown within each cumulative incidence curve pane.
Figure 5
Figure 5. Cumulative Incidence and Median Time to KPD in NKR by Candidate and Donor ABO Type
Median times to KPD, in months, and number of KPDs are shown within each cumulative incidence curve pane.
See this image and copyright information in PMC

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