Landscape of Living Multiorgan Donation in the United States: A Registry-Based Cohort Study

Macey Henderson, Sandra R. Dibrito, Alvin G. Thomas, Courtenay M. Holscher, Ashton A. Shaffer, Mary Grace Bowring, Tanjala Purnell, Allan B Massie, Jacqueline Garonzik, Madeleine M. Waldram, Krista L. Lentine, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Background The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. Methods Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. Results The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors. Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.

Original languageEnglish (US)
Pages (from-to)1148-1155
Number of pages8
JournalTransplantation
Volume102
Issue number7
DOIs
StatePublished - Jul 1 2018

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Living Donors
Registries
Cohort Studies
Tissue Donors
Kidney
Liver
Transplants
Pancreas
Graft Survival
Intestines
Lung
Survival
Informed Consent
Documentation
Allografts

ASJC Scopus subject areas

  • Transplantation

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Landscape of Living Multiorgan Donation in the United States : A Registry-Based Cohort Study. / Henderson, Macey; Dibrito, Sandra R.; Thomas, Alvin G.; Holscher, Courtenay M.; Shaffer, Ashton A.; Bowring, Mary Grace; Purnell, Tanjala; Massie, Allan B; Garonzik, Jacqueline; Waldram, Madeleine M.; Lentine, Krista L.; Segev, Dorry.

In: Transplantation, Vol. 102, No. 7, 01.07.2018, p. 1148-1155.

Research output: Contribution to journalArticle

Henderson, Macey ; Dibrito, Sandra R. ; Thomas, Alvin G. ; Holscher, Courtenay M. ; Shaffer, Ashton A. ; Bowring, Mary Grace ; Purnell, Tanjala ; Massie, Allan B ; Garonzik, Jacqueline ; Waldram, Madeleine M. ; Lentine, Krista L. ; Segev, Dorry. / Landscape of Living Multiorgan Donation in the United States : A Registry-Based Cohort Study. In: Transplantation. 2018 ; Vol. 102, No. 7. pp. 1148-1155.
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abstract = "Background The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. Methods Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. Results The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38{\%} donated 2 grafts to the same recipient and 15{\%} donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors. Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.",
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AU - Henderson, Macey

AU - Dibrito, Sandra R.

AU - Thomas, Alvin G.

AU - Holscher, Courtenay M.

AU - Shaffer, Ashton A.

AU - Bowring, Mary Grace

AU - Purnell, Tanjala

AU - Massie, Allan B

AU - Garonzik, Jacqueline

AU - Waldram, Madeleine M.

AU - Lentine, Krista L.

AU - Segev, Dorry

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N2 - Background The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. Methods Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. Results The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors. Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.

AB - Background The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. Methods Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. Results The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors. Conclusions Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.

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