Early Outcomes of Transplant
Recipients in the OPTN Kidney
Paired Donation Pilot Program
Mark Aeder, MD, University Hospitals Case Med Center
Darren Stewart, MS, UNOS
Ruthanne Leishman, RN, MPH UNOS
Tuomas Sandholm, PhD, Carnegie Mellon University
Richard Formica, MD, Yale University
Disclosures
None of the authors of this abstract have any financial
relationships to declare relative to the materials
presented.
Background

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
OPTN KPDPP Transplants
120
110
100
79
80
60
40
27
17
20
2
0
As of July 24: 110 transplants
Paired Transplants

Chains and 3-way exchanges comprised 90% of the
transplants
Transplants by Ethnicity
Ethnicity
OPTN/UNOS OPTN/UNOS
KPDPP Listing KPDPP Tx
(904)#
(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%
# - 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
Data/Methods

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”
Shipping of Kidneys in OPTN KPDPP
Kidneys Shipped
Donor Traveled for
Donation
Donor and Recipient at
Same Hospital
75 (90.4%)
2 (2.4%)
6 (7.2%)
Inter-regional Shipping (to Regions 1, 2 ,3)
N=1
N=1
N=2
N=1
N=1
N=3
N=2
N=1
N=6
N=2
N=1
N=2
16,191
4,174
Frequent flyer miles: 10,682
73% (n=61) kidneys shipped inter-regionally.
Inter-regional Shipping (to Regions 4, 5, 6, 7)
N=1
N=1
N=1
N=1
N=1
N=1
N=1
N=1
N=2
37,189
29,468
23,758
Frequent flyer miles: 22,061
Inter-regional Shipping (to Regions 8 – 11)
N=2
N=1
N=1
N=2
N=1
N=1
N=1
N=1
N=2
N=1
44,752
43,131
41,714
Frequent flyer miles: 40,539
Total of 40 different inter-regional combinations
have occurred (12, 21, 27, 43, etc).
Outcomes Summary
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
1,677
2.0
4.4
98.0
Non-OPTN KPD
Early Graft Survival
Summary

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
Conclusion

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