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. 2022 Mar 22;7(6):1289-1305.
doi: 10.1016/j.ekir.2022.03.012. eCollection 2022 Jun.

Nondirected Living Kidney Donation and Recipient Outcomes in the United States: A 20-Year Review

Muhammad Y Jan  1 , Muhammad S Yaqub  1 , Oluwafisayo O Adebiyi  1 , Tim E Taber  1 , Melissa D Anderson  1 , Dennis P Mishler  1 , Heather N Burney  2 , Yang Li  2 , Xiaochun Li  2 , Asif A Sharfuddin  1
Affiliations

Nondirected Living Kidney Donation and Recipient Outcomes in the United States: A 20-Year Review

Muhammad Y Jan et al. Kidney Int Rep. .

Abstract

Introduction: Nondirected donation (NDD) of the kidneys is a growing practice where donors who do not have any genetic or emotional relationship are selected to donate to a wide variety of recipients with a range of selection criteria and decisions which are left up to individual transplant centers.

Methods: We review all adult living kidney donor-recipient (DR) pairs and outcomes from NDDs who were recorded in United Network for Organ Sharing (UNOS) database as code 10 (anonymous) from October 1997 to September 2017 for demographics and outcomes.

Results: A total of 2174 DR pairs were identified. The number of NDDs increased from 18 in 2000 to 256 in 2016. Survival analysis showed higher death-censored-graft survival (DC-GS) when recipient was 20 years or more older than donor followed by recipient-donor within 20 years of age and lowest when donor was 20 years or more older than recipient (P = 0.0114).

Conclusion: Overall, the number of NDDs has increased significantly in the 20-year review period. Transplants from NDDs have excellent long-term outcomes. Better matching of controllable DR factors, such as age and body mass index (BMI), could further improve GS. Further research is needed to incorporate these DR factors into paired kidney donation programs potentially enhancing the utility and beneficence of this invaluable donation.

Keywords: donor-recipient matching; living kidney donation; nondirected kidney donation; paired exchange.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Number of nondirected kidney donations in the United States from 1997 to 2017. Graph of yearly nondirected donor transplant activity.
Figure 2
Figure 2
(a) Overall patient survival, (b) graft survival, and (c) death-censored graft survival. NE, not estimable; OS, overall survival.
Figure 3
Figure 3
Graft survival using Kaplan–Meier curve by age mismatch category. GS, graft survival; NE, not estimable.
Figure 4
Figure 4
Death-censored graft survival Kaplan–Meier curve by age mismatch category. DC-GS, death-censored graft survival; NE, not estimable.
Figure 5
Figure 5
Graft survival Kaplan–Meier curve by BMI mismatch category. BMI, body mass index.
Figure 6
Figure 6
Death-censored graft survival Kaplan–Meier curve by BMI mismatch category. BMI, body mass index; NE, not estimable.
Figure 7
Figure 7
Distribution of age mismatch, where age mismatch = recipient age – donor age.
Figure 8
Figure 8
Distribution of BMI mismatch, where BMI mismatch = recipient BMI – donor BMI. BMI, body mass index.
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