TY - JOUR
T1 - Early graft losses in paired kidney exchange
T2 - Experience from 10 years of the National Kidney Registry
AU - Verbesey, Jennifer
AU - Thomas, Alvin G.
AU - Ronin, Matt
AU - Beaumont, Jennifer
AU - Waterman, Amy
AU - Segev, Dorry L.
AU - Flechner, Stuart M.
AU - Cooper, Matthew
N1 - Funding Information:
Funding for this study was provided in part by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) and National Heart, Lung, and Blood Institute (NHBLI) grant numbers T32HL007055 (Alvin Thomas) and K24DK101828 (PI: Dorry Segev). In addition, Dorry Segev is supported by a Doris Duke Charitable Foundation Clinical Research Mentorship grant and a research grant from the National Kidney Registry. The National Kidney Registry had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The other sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
The authors of this manuscript have conflicts of interest to disclose as described by the All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Mr Thomas and Dr Segev reported institutional grant support from the National Institutes of Health. Dr Segev also report institutional grant support from the Doris Duke Charitable Foundation and National Kidney Registry. Mr Ronin is a full‐time, paid employee of the National Kidney Registry. The other authors have no conflicts of interest to disclose. American Journal of Transplantation.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Cooperative kidney paired donation (KPD) networks account for an increasing proportion of all living donor kidney transplants in the United States. There are sparse data on the rate of primary nonfunction (PNF) losses and their consequences within KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of transplantation, and graft losses in the first-year posttransplant and assessed potential risk factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 (0.5%) with PNF. When compared to functioning grafts, there were no clinically significant differences in blood type compatibility, degree of HLA mismatch, number of veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and development of antibody-mediated rejection (AMR). Given the low rate of PNF, the NKR created a policy to allocate chain-end kidneys to recipients with PNF following event review and attributable to surgical issues of donor nephrectomy. It is expected that demonstration of low incidence of poor early graft outcomes and the presence of a “safety net” would further encourage program participation in national KPD.
AB - Cooperative kidney paired donation (KPD) networks account for an increasing proportion of all living donor kidney transplants in the United States. There are sparse data on the rate of primary nonfunction (PNF) losses and their consequences within KPD networks. We studied National Kidney Registry (NKR) transplants (February 14, 2009 to December 31, 2017) and quantified PNF, graft loss within 30 days of transplantation, and graft losses in the first-year posttransplant and assessed potential risk factors. Of 2364 transplants, there were 38 grafts (1.6%) lost within the first year, 13 (0.5%) with PNF. When compared to functioning grafts, there were no clinically significant differences in blood type compatibility, degree of HLA mismatch, number of veins/arteries, cold ischemia, and travel times. Of 13 PNF cases, 2 were due to early venous thrombosis, 2 to arterial thrombosis, and 2 to failure of desensitization and development of antibody-mediated rejection (AMR). Given the low rate of PNF, the NKR created a policy to allocate chain-end kidneys to recipients with PNF following event review and attributable to surgical issues of donor nephrectomy. It is expected that demonstration of low incidence of poor early graft outcomes and the presence of a “safety net” would further encourage program participation in national KPD.
KW - clinical research/practice
KW - donors and donation: living
KW - graft survival
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
KW - primary nonfunction
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U2 - 10.1111/ajt.15778
DO - 10.1111/ajt.15778
M3 - Article
C2 - 31922651
AN - SCOPUS:85078755698
SN - 1600-6135
VL - 20
SP - 1393
EP - 1401
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -