*Purpose: Compatible pairs (CPs) can enter an exchange program instead of donating directly. These pairs increase transplants (txp) by providing additional donors within an exchange program. We aim to quantify the benefit for the recipients.

*Methods: For CPs that entered into the National Kidney Registry (NKR) between 2/14/08 and 1/15/19, the paired donor (PD) was compared against the matched donor (MD). We tallied the reasons pts entered the exchange, and characteristics (age, HLA, height, weight, creatinine clearance (CrCl), anatomy, hypertension (HTN), sex, HLA avoids, kidney life years (KLY), LKDPI, relationship and race) of the PD and the MD.

*Results: 162 CPs were txp’ed. 78 centers reported their reason for entry with “seeking a better HLA match”, “seeking a younger donor” and “Seeking a larger donor/kidney” being most commonly cited (Figure 1). The most common advantages noted were receiving a younger donor (N=113), KLY (N=99), improved HLA match (N=78), and avoiding a low level DSA (N=54) (Figure 2). The median LKDPI improvement was 25 points, with an average CrCl for a MD of 126.6 versus 122.6 of the PD and an average cold ischemic time of 9 hours. 320 additional txp were made possible, 40 with a cPRA >80%, of which 20 were>95%. 60 ABO: O recipients were txp’ed by O donors who would have otherwise donated to non-O recipients.

*Conclusions: CPs improve the match a pt otherwise would receive by participating in paired exchange as well as unlocking many difficult to match pairs. Txp centers control which characteristics are most important. These options should be discussed by providers to improve matching and increase opportunities for hard to match pts.

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