Background We sought to identify donor characteristics influencing long-term graft survival, expressed by a novel measure, kidney life years (KLYs), in living donor kidney transplantation (LDKT). Methods Cox and multiple regression analyses were applied to data from the Scientific Registry for Transplant Research from 1987 to 2015. Dependent variable was KLYs. Results Living donor kidney transplantation (129 273) were performed from 1987 to 2013 in the United States. To allow sufficient time to assess long-term results, outcomes of LDKTs between 1987 and 2001 were analyzed. After excluding cases where a patient died with a functioning graft (8301) or those missing HLA data (9), 40 371 cases were analyzed. Of 18 independent variables, the focus became the 4 variables that were the most statistically and clinically significant in that they are potentially modifiable in donor selection ( P <0.0001; ie, HLA match points, donor sex, donor biological sibling and donor age). HLA match points had the strongest relationship with KLYs, was associated with the greatest tendency toward graft longevity on Cox regression, and had the largest increase in KLYs (2.0 year increase per 50 antigen Match Points) based on multiple regression. Conclusions In cases when a patient has multiple potential donors, such as through paired exchange, graft life might be extended when a donor with favorable matching characteristics is selected.

BACKGROUND:Although kidney paired donation (KPD) has led to thousands of transplants, the 2012 KPD Consensus Conference concluded that more could be done. Perceptions are that a large number of match offers never resulted in transplantations, and unfruitful matches have both financial and emotional costs.METHODS:To describe, quantify, and analyze the unrealized match offers, we studied the matching process from registration to transplantation in the National Kidney Registry, a large KPD registry, over a 25-month period.RESULTS:Of the 3,180 match offers, 454 were turned down. The most common reasons were the donor was not acceptable (50%) and their recipient had unacceptably high donor-specific antibodies (28%). Of the 2,228 accepted offers, 1,335 advanced to the cell-based cross-match stage because 893 of these were part of chains that fell through. Fifty-five of 887 recorded cell-based cross-matches were positive, 20 donors were unacceptable, and 22 recipients had unacceptably high donor-specific antibodies. Six hundred ninety transplantations were performed.CONCLUSION:Despite the success of KPD, by analyzing the matching process, we identify several strategies to increase the number of KPD transplantations, including recruiting more participants, processing the match offers more quickly at the transplant center level, enhancing the donor preselection tools, improving communication between centers and the registries, and combining desensitization with KPD.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery II1 Apr 20122280 WAIT-TIME VARIES BY BLOOD-TYPE AND CALCULATED PANEL REACTIVE ANTIBODY FOR INCOMPATIBLE PAIRS IN KIDNEY EXCHANGE Jeff Veale, Marc Melcher, Connie Davis, Elizabeth Berger, Joe Sinacore, Matt Ronin, Garet Hil, and John Milner Jeff VealeJeff Veale LA, CA More articles by this author , Marc MelcherMarc Melcher Stanford, CA More articles by this author , Connie DavisConnie Davis Seattle, WA More articles by this author , Elizabeth BergerElizabeth Berger Maywood, IL More articles by this author , Joe SinacoreJoe Sinacore Babylon, NY More articles by this author , Matt RoninMatt Ronin Babylon, NY More articles by this author , Garet HilGaret Hil Babylon, NY More articles by this author , and John MilnerJohn Milner Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2458AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Though important, time waiting to kidney transplant has not been a major focus of transplant centers in regard to a potential kidney transplant recipient waiting with an incompatible living donor. The purpose of this study is to report time-waiting-to-transplant in a large, multi-institutional kidney transplant exchange registry. METHODS A 2-year interval from January 2010 to December 2011 was defined to review time waiting to transplant in a prospectively gathered, multi-institutional registry database created for incompatible living donor-recipient pairs seeking a compatible transplant by exchanging donors. The database was reviewed for recipient wait-time from registration to transplants completed during the interval, and further stratified by the blood types of the incompatible living donor and recipient, and the calculated panel reactive antibody of the recipient assessing how these variables influence wait-time. RESULTS During the interval, a total of 190 transplants were performed, 6 via loops, and 184 via chains. 54 chains were active, 50 eventually closing to the standard wait-list, 2 ongoing, and 2 broken when a bridge donor became unavailable. The average wait-time from registration to transplant was 4 months for recipients with a cPRA of 0 (n=80), 5 months for a cPRA of 0-80% (n=46), 6 months for a cPRA of 80-95% (n=35), and 9 months for a cPRA > 95% (n=29), with an overall wait-time for those transplanted of 6 months (n=190). The average wait-time was 4 months (n=7) for blood type AB recipients, 5 months (n=66) for blood type A recipients, 6 months (n=33) for blood type B recipients, and 8 months (n=84) for blood type O recipients. On the other hand, 212 patients were still awaiting transplant with enrollments continuing throughout the interval, 15% having a cPRA of 0% (n=31), 11% a cPRA of 0-80% (n=24), 8% a cPRA of 80-95% (n=16), and 67% a cPRA of >95% (n=141). A majority of patients still waiting had non-blood type O incompatible donors (n=128), and were sensitized with donor specific antibody (n=181). CONCLUSIONS Wait-time increases with increasing recipient cPRA, and varies by the blood type of the incompatible donor and recipient with blood type O recipients waiting longer on average than blood type B recipients, followed by blood type A recipients, with blood type AB recipients waiting the shortest time to exchange transplant. Sensitized patients who register blood type O incompatible donors, and who register more than one incompatible donor may increase their probability of finding a match more quickly. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e919-e920 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeff Veale LA, CA More articles by this author Marc Melcher Stanford, CA More articles by this author Connie Davis Seattle, WA More articles by this author Elizabeth Berger Maywood, IL More articles by this author Joe Sinacore Babylon, NY More articles by this author Matt Ronin Babylon, NY More articles by this author Garet Hil Babylon, NY More articles by this author John Milner Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...