Temporal changes in the composition of a large multicenter kidney exchange clearinghouse: Do the hard-to-match accumulate?

Am J Transplant. 2018 Nov;18(11):2791-2797. doi: 10.1111/ajt.15046. Epub 2018 Sep 12.

Abstract

One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P = .03), the proportion decreased to 17% by June 2016 (P < .001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P = .02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.

Keywords: donors and donation: living; donors and donation: paired exchange; health services and outcomes research; kidney transplantation/nephrology; kidney transplantation: living donor; sensitization.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Grouping and Crossmatching
  • Donor Selection / organization & administration*
  • Female
  • Follow-Up Studies
  • Histocompatibility Testing
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Prognosis
  • Registries
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / organization & administration*