Early Outcomes of Transplant Recipients in the OPTN Kidney Paired Donation Pilot Program

Mark Aeder, MD, University Hospitals Case Med CenterDarren Stewart, MS, UNOS

Ruthanne Leishman, RN, MPH UNOSTuomas Sandholm, PhD, Carnegie Mellon University

Richard Formica, MD, Yale University

None of the authors of this abstract have any financial relationships to declare relative to the materials

presented.

Disclosures

The KPD Pilot Program was late to the KPD arena as the proposal released for public comment in 2006, Board approved in 2008, and performed the first transplant in 2010.

Reached the “tipping point” in national participation

Now have the opportunity to present early outcomes

Background

OPTN KPDPP Transplants

As of July 24: 110 transplants

Chains and 3-way exchanges comprised 90% of the transplants

Paired Transplants

Ethnicity OPTN/UNOS KPDPP Listing (904)#

OPTN/UNOSKPDPP Tx (88)#

National Living Donor Tx* (23,401)

National New Kidney Listings* (145,413)

National All DD Tx* (67,097)

White 69% 65% 66% 46% 44%

AA 15% 21% 13% 29% 32%

Hispanic 10% 3% 14% 17% 16%

Asian 5% 6% 5% 7% 6%

Transplants by Ethnicity

# - Through 3/31/14* - Aggregate 1/1/2010- 12/31/2013

Time Waiting following Listing for KPDPP Transplant Recipients

Outcomes after Being Added to KPD System

After 1 year, about half are still waiting; 43% transplanted by OPTN KPDPP or other means.

Expanding Access

From 10/2010 through 2/2014, 83 KPD transplant were facilitated through the OPTN KPDPP

During this time, 19,028 other living donor (LD) and 34,709 deceased donor (DD) were performed

6 month outcomes were reviewed on these cohorts with regard to key outcomes

KPD transplants outside of pilot program identified by living donor relationship reported as “paired donation”

Data/Methods

Kidneys Shipped Donor Traveled for Donation

Donor and Recipient at Same Hospital

75 (90.4%) 2 (2.4%) 6 (7.2%)

Shipping of Kidneys in OPTN KPDPP

N=1

N=2

N=2

N=3

N=1

N=1N=6

N=1

N=1N=2

N=3

N=1

N=2

N=1N=1

Inter-regional Shipping (to Regions 1, 2 ,3)

73% (n=61) kidneys shipped inter-regionally.

Frequent flyer miles: 4,17410,68216,191

N=1

N=1

N=1N=1

N=1

N=1

N=1

N=3

N=3

N=1

N=2

N=1

N=1

N=1

Inter-regional Shipping (to Regions 4, 5, 6, 7)

Frequent flyer miles: 22,06123,75829,46837,189

N=2

N=1N=2

N=1

N=1 N=1

N=2

N=1N=1

N=1

N=1

Total of 40 different inter-regional combinations have occurred (12, 21, 27, 43, etc).

Inter-regional Shipping (to Regions 8 – 11)

Frequent flyer miles: 40,53941,71443,13144,752

Transplant Type # Transplants Median CIT (hr) % DGF % GS (6 mo) KM

OPTN KPDPP 83 8.0 2.4 98.8

Other LD KTx 19,028 1.0 3.1 98.1

DD Tx 34,709 15.9 24.8 95.1

Outcomes Summary

Early Graft Survival

Over 90% of the shared kidneys were shipped from the donor to the recipient center with a median CIT of 8 hours

Despite the longer CIT, DGF was equitant with the national cohort of LD transplants (2.4%) and less than DD tx 24.8%

The distribution of KPDPP recipients was relatively similar to the candidate entry into the program. One notable exception is that AA recipients represented 21% of the recipients (compared to 13% for all LD)

Summary

KPDPP Initial 6 month graft survival (98.8%) was equivalent to all LD graft survival (98.1%) and improved compared to DD transplant recipients (95.1%)

Although time to listing in the KPDPP was over 500 days from initial transplant listing, the median time to transplant for the recipients was 187 days and over 80% of the transplanted recipients waited less than a year

Summary

The KPDPP has proved excellent 6 month outcomes that are comparable to the entire national LD recipient population

Shipping kidneys in the KPDPP, despite longer CIT, does not appear to have a detrimental effect on outcomes

All patients with a willing but incompatible living donor should be offered an early opportunity to be listed as a donor-recipient pair in the OPTN/UNOS KPDPP

Conclusion