Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Melcher, Marc L.; Veale, Jeffrey L.; Javaid, Basit; Leeser, David B.; Davis, Connie L.; Hil, Garet; Milner, John

doi:10.1001/2013.jamasurg.25

Cited by 51 publications

(37 citation statements)

References 18 publications

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“…4 All participants should consider options that may translate into greater graft longevity or KLYs. There are at least 8 reasons why a participant (either compatible or incompatible) may choose to enroll in KPD with the goal of “trading-up” for a better outcome through donor optimization (measured in KLYs) among other reasons, listed as follows: (1) transplants may last longer (ie, higher expected KLYs) with better donor selection; (2) recipients may require less immunosuppression with better matching, and therefore experience less side effects from medication; (3) recipients may experience less morbidity/mortality by seeking a better match, especially in cases where aggressive desensitization can be avoided entirely 16-18 ; (4) recipients will be easier to transplant in the future (either with a living, or deceased donor) should they require it, because they will be sensitized to fewer antigens (DSA) 20 ; (5) participants help others while at the same time helping the intended recipient who faces the possibility of a repeat transplant if a graft fails—this not only by offloading competition on the waitlist by enabling more transplants per unit time, but also by facilitating more difficult to accomplish transplants in sensitized cohorts of recipients of which the intended recipient may become a member (by developing DSA) should they require a repeat transplant in the future, these concepts being supported by the mathematics driving KPD 3,4,20,21 (6) donor-recipient anatomic, and other physiologic considerations ( eg, CMV, EBV status); (7) registration in an advanced donation program, 22 and; (8) altruistic motives, “helping the greater good,” by creating more transplants via KPD. Confidence in KPD is growing—allowing for mainstream KLYs optimization to take place—and is reinforced by early results showing favorable outcomes with shipped living donor kidneys.…”

Section: Discussionmentioning

confidence: 99%

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

Milner

Melcher

Lee

et al. 2016

Transplantation Direct

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BackgroundWe 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).MethodsCox and multiple regression analyses were applied to data from the Scientific Registry for Transplant Research from 1987 to 2015. Dependent variable was KLYs.ResultsLiving 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.ConclusionsIn 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.

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Section: Discussionmentioning

confidence: 99%

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

Milner

Melcher

Lee

et al. 2016

Transplantation Direct

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“…Kidney paired donation (KPD) is an effective means of overcoming immunological barriers to living donor transplantation (1–12). The competition engendered by various paired donation registries has led to unique strategies and innovations (13).…”

Section: Introductionmentioning

confidence: 99%

Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System

Fumo

Kapoor

Reece³

et al. 2015

American Journal of Transplantation

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Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from “offers” to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The “offer” and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.

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“…These chains may be simultaneous where all of the transplants occur over a period of 1 to a few days or nonsimultaneous extended chains. (4)(5)(6) In the nonsimultaneous setting, bridge donors may wait days to months until additional pairs are added to the chain. In either scenario, most chains are ultimately ended with donation of a living donor kidney to a recipient on the deceased donor list.…”

Section: Kidney Paired Exchange Backgroundmentioning

confidence: 99%

Liver paired exchange: Can the liver emulate the kidney?

Mishra

Lee

et al. 2018

Liver Transpl

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Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.

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Kidney Transplant Chains Amplify Benefit of Nondirected Donors

Cited by 51 publications

References 18 publications

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

HLA Matching Trumps Donor Age: Donor-Recipient Pairing Characteristics That Impact Long-Term Success in Living Donor Kidney Transplantation in the Era of Paired Kidney Exchange

Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System

Liver paired exchange: Can the liver emulate the kidney?

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