Background: The success of a national KPD program is predicated on excellent early kidney function and graft survival (GS). As other KPD programs have reported increased delayed graft function (DGF) with CIT >8 hours (hrs), we assessed CIT and early outcomes (GS, DGF) for KPDPP kidneys and other living and deceased donor kidney transplants (tx). We also examined DT for KPDPP transplants.

Methods: DGF and Kaplan-Meier GS rates for KPDPP tx (n=111) performed between 10/2010-9/2014 were compared to other kidney tx: KPD (intra- and inter-hospital) (n=1,927); other living donor (LD) (n=20,431); and deceased donor (DD) (n=41,424). Additionally, DGF by CIT was assessed for all shipped LD kidneys (n=1,582). Shipped kidneys were those with different recovery vs. transplant hospital. An exact likelihood ratio chi-squared test was used to compare DGF rates. Results are based on OPTN data as of Nov 7.

Results: GS at 6 months for KPDPP tx was statistically no different from other KPD tx (p=0.59) and other LD tx (p=0.30), despite higher median CIT (8 hrs v 2.2 hrs v 1 hr). Of KPDPP tx, 103 (89%) kidneys were shipped (74% interregionally) including 49 (48%) >500 miles and 13 (13%) >1000 miles. Median CIT was 8 hrs (range: <1 to 26 hrs) and 2 kidneys (1.8%) experienced DGF (Table 1). Zero hospitals reported DGF for any KPDPP shipped kidneys with CIT ≥8 hours (n=55). Though statistical significance was borderline (p=0.05), this contrasted with a 5.8% DGF rate for other shipped LD tx with CIT ≥ 8 hrs. However, the DGF rate for shipped LD kidneys was markedly less than in DD tx (DGF=12.8% at 0-4 hrs; 26.7% at 16-20 hrs).

Conclusions: Shipped KPD kidneys are a safe option for LD tx even when the CIT will exceed 8 hours and DT >1000 miles, having a substantially lower DGF rate than DD tx. Additionally, shipped LD tx have equivalent GS at 6 months compared with non-shipped LD tx.

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