The first 9 years of kidney paired donation through the National Kidney Registry: Characteristics of donors and recipients compared with National Live Donor Transplant Registries

Abstract

The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplant to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared with national registries. For this purpose, we merged data from the NKR database with the Scientific Registry of Transplant Recipients (SRTR) database, from February 14, 2008, to February 14, 2017, encompassing the first 9 years of the NKR. Compared with all United Network for Organ Sharing (UNOS) live donor transplant patients (49 610), all UNOS living unrelated transplant patients (23 319), and all other KPD transplant patients (4236), the demographic and clinical characteristics of NKR transplant patients (2037) appear similar to contemporary national trends. In particular, among the NKR patients, there were a significantly (P < .001) greater number of retransplants (25.6% vs 11.5%), hyperimmunized recipients (22.7% vs 4.3% were cPRA >80%), female recipients (45.9% vs 37.6%), black recipients (18.2% vs 13%), and those on public insurance (49.7% vs 41.8%) compared with controls. These results support the need for greater sharing and larger pool sizes, perhaps enhanced by the entry of compatible pairs and even chains initiated by deceased donors, to unlock more opportunities for those harder-to-match pairs.

The 6‐year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program ‐ a retrospective study

“…Recent reports described individual KPD programs with their own complexity and uniqueness [33,35,[49][50][51][52]. While demographics of the National Kidney Registry (NKR) were similar to other KPD and UNOS live donor programs, the NKR had 22.7% HS/VHS patients (cPRA > 80%) in comparison to 4.3% among LD in UNOS [51].…”

Desensitization strategies: is it worth it?

“…A more recent report compared transplant rates of a KPD network (NKR – National Kidney Registry) with the Scientific Registry of Transplant Recipients database . NKR transplants were performed on a significantly greater proportion of HLA hyperimmunized patients.…”

“…Only 45.8% of the NKR recipients had a pretransplant cPRA of 0%, compared to 71.3% of all living kidney transplants, and 71% of living unrelated transplants in the UNOS. The NKR transplants representing the hard‐to‐match cPRA ranges of 80–97% were accomplished for 15.3% of the recipients compared to only 3% of all living kidney transplants, and 3.1% of living unrelated transplants in the United Network for Organ Sharing . It is important to identify patients not transplanted after entering into KPD as well.…”

“…It is important to identify patients not transplanted after entering into KPD as well. In the NKR registry those unmatched based on cPRA were 23% for cPRA of 0%, 22% for a cPRA of 1% to 79%, 8% for a cPRA of 80% to 95%, 18% for a cPRA of 95% to 99% and 29% if they had a cPRA of 100% .…”

The Benefits of a Local Kidney Exchange

“…In Texas, local KPD exchange programs have reported steady increases in transplant volume because of increased awareness and the motivation to find live-donor kidneys for more recipients. 16,17 The generosity of altruistic, anonymous donors in KPD programs can increase transplant rates beyond those of direct donation. 18 Moreover, optimized matching algorithms for selecting compatible donor-recipient pairs are crucial in maximizing the benefits of KPD programs.…”