Shipping living donor kidneys and transplant recipient outcomes

Eric Treat, Eric K.H. Chow, John D. Peipert, Amy Waterman, Lorna Kwan, Allan B Massie, Alvin G. Thomas, Mary Grace Bowring, David Leeser, Stuart Flechner, Marc L. Melcher, Sandip Kapur, Dorry Segev, Jeffrey Veale

Research output: Contribution to journalArticle

Abstract

Kidney paired donation (KPD) is an important tool to facilitate living donor kidney transplantation (LDKT). Concerns remain over prolonged cold ischemia times (CIT) associated with shipping kidneys long distances through KPD. We examined the association between CIT and delayed graft function (DGF), allograft survival, and patient survival for 1267 shipped and 205 nonshipped/internal KPD LDKTs facilitated by the National Kidney Registry in the United States from 2008 to 2015, compared to 4800 unrelated, nonshipped, non-KPD LDKTs. Shipped KPD recipients had a median CIT of 9.3 hours (range = 0.25-23.9 hours), compared to 1.0 hour for internal KPD transplants and 0.93 hours for non-KPD LDKTs. Each hour of CIT was associated with a 5% increased odds of DGF (adjusted odds ratio: 1.05, 95% confidence interval [CI], 1.02-1.09, P < .01). However, there was not a significant association between CIT and all-cause graft failure (adjusted hazard ratio [aHR]: 1.01, 95% CI: 0.98-1.04, P = .4), death-censored graft failure ( [aHR]: 1.02, 95% CI, 0.98-1.06, P = .4), or mortality (aHR 1.00, 95% CI, 0.96-1.04, P > .9). This study of KPD-facilitated LDKTs found no evidence that long CIT is a concern for reduced graft or patient survival. Studies with longer follow-up are needed to refine our understanding of the safety of shipping donor kidneys through KPD.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2017

Keywords

  • Clinical research/practice
  • Delayed graft function (DGF)
  • Donors and donation: paired exchange
  • Graft survival
  • Health services and outcomes research
  • Kidney transplantation/nephrology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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  • Cite this

    Treat, E., Chow, E. K. H., Peipert, J. D., Waterman, A., Kwan, L., Massie, A. B., Thomas, A. G., Bowring, M. G., Leeser, D., Flechner, S., Melcher, M. L., Kapur, S., Segev, D., & Veale, J. (Accepted/In press). Shipping living donor kidneys and transplant recipient outcomes. American Journal of Transplantation. https://doi.org/10.1111/ajt.14597