Kidney exchange match rates in a large multicenter clearinghouse

Courtenay M. Holscher, Kyle Jackson, Eric K.H. Chow, Alvin G. Thomas, Christine E. Haugen, Sandra R. Dibrito, Carlin Purcell, Matthew Ronin, Amy D. Waterman, Jacqueline Garonzik, Allan B Massie, Sommer Elizabeth Gentry, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Kidney paired donation (KPD) can facilitate living donor transplantation for candidates with an incompatible donor, but requires waiting for a match while experiencing the morbidity of dialysis. The balance between waiting for KPD vs desensitization or deceased donor transplantation relies on the ability to estimate KPD wait times. We studied donor/candidate pairs in the National Kidney Registry (NKR), a large multicenter KPD clearinghouse, between October 2011 and September 2015 using a competing-risk framework. Among 1894 candidates, 52% were male, median age was 50 years, 66% were white, 59% had blood type O, 42% had panel reactive antibody (PRA)>80, and 50% obtained KPD through NKR. Median times to KPD ranged from 2 months for candidates with ABO-A and PRA 0, to over a year for candidates with ABO-O or PRA 98+. Candidates with PRA 80-97 and 98+ were 23% (95% confidence interval , 6%-37%) and 83% (78%-87%) less likely to be matched than PRA 0 candidates. ABO-O candidates were 67% (61%-73%) less likely to be matched than ABO-A candidates. Candidates with ABO-B or ABO-O donors were 31% (10%-56%) and 118% (82%-162%) more likely to match than those with ABO-A donors. Providers should counsel candidates about realistic, individualized expectations for KPD, especially in the context of their alternative treatment options.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • ABO incompatibility
  • Clinical research/practice
  • Donors and donation
  • Donors and donation: paired exchange
  • Health services and outcomes research
  • Kidney transplantation/nephrology
  • Kidney transplantation: living donor
  • Panel reactive antibody (PRA)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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  • Cite this

    Holscher, C. M., Jackson, K., Chow, E. K. H., Thomas, A. G., Haugen, C. E., Dibrito, S. R., Purcell, C., Ronin, M., Waterman, A. D., Garonzik, J., Massie, A. B., Gentry, S. E., & Segev, D. (Accepted/In press). Kidney exchange match rates in a large multicenter clearinghouse. American Journal of Transplantation. https://doi.org/10.1111/ajt.14689