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. 2022 Jan;22(1):266-273.
doi: 10.1111/ajt.16821. Epub 2021 Sep 12.

Motivations and outcomes of compatible living donor-recipient pairs in paired exchange

Valerie Chipman  1   2 , Matthew Cooper  3 , Alvin G Thomas  4   5 , Matthew Ronin  6 , Brian Lee  7 , Stuart Flechner  8 , David Leeser  9 , Dorry L Segev  4   10   11 , Didier A Mandelbrot  12 , Tyler Lunow-Luke  1 , Shareef Syed  1 , Garet Hil  6 , Chris E Freise  1 , Amy D Waterman  13   14 , Garrett R Roll  1
Affiliations

Motivations and outcomes of compatible living donor-recipient pairs in paired exchange

Valerie Chipman et al. Am J Transplant. 2022 Jan.

Abstract

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.

Keywords: clinical decision-making; clinical research/practice; donors and donation: paired exchange; health services and outcomes research; kidney transplantation/nephrology; kidney transplantation: living donor; patient education.

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Figures

FIGURE 1
FIGURE 1
Posttransplant outcomes of graft failure (A) and mortality (B) comparing originally compatible recipients to originally incompatible (traditional) paired exchange recipients
See this image and copyright information in PMC

References

    1. Gentry SE, Montgomery RA, Segev DL. Kidney paired donation: fundamentals, limitations, and expansions. Am J Kidney Dis. 2011;57(1):144–151. - PubMed
    1. Segev DL, Gentry SE, Warren DS, Reeb B, Montgomery RA. Kidney paired donation and optimizing the use of live donor organs. JAMA. 2005;293(15):1883–1890. - PubMed
    1. Segev DL, Kucirka LM, Gentry SE, Montgomery RA. Utilization and outcomes of kidney paired donation in the United States. Transplantation. 2008;86(4):502–510. - PubMed
    1. D’Alessandro T, Veale JL. Innovations in kidney paired donation transplantation. Curr Opin Organ Transplant. 2019;24(4):429–433. - PubMed
    1. Treat E, Chow EKH, Peipert JD, et al. Shipping living donor kidneys and transplant recipient outcomes. Am J Transplant. 2018;18(3):632–641. - PMC - PubMed

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