Living donor (LD) kidney (K) transplants (Tx), which peaked at 6647 in 2004 (42.5% of tx), decreased by 2014 to 5538 (32.4% of tx). Although reasons (changing donor demographics, aging donor/recipient candidates, etc.) are debated, geographic logistics, i.e., requiring the donor to travel to the recipient center (travel/housing costs, family employment considerations, loss of local support network), is a significant barrier preventing many LDKTx possibilities.

Kidney Paired Donation (KPD) is a well-accepted process for exchanging kidneys between biologically incompatible donor candidate pairs, allowing each recipient to receive a LDK. KPD represents nearly 10% of LDTx. Often these kidneys are retrieved at a center geographically close to the donor's residence and shipped to the recipient's hospital over long distances.

Methods: The OPTN/UNOS KPD pilot program assessed early outcomes for kidneys by kidney distance traveled, cold ischemic time (CIT), delayed graft function (DGF), and early graft survival (GS). All 111 Tx performed between 10/2010- 9/2014 were compared to other intra and inter hospital KPD transplants (n=1,927) as well as all directed (non-KPD) LDK Tx (n=20,431) and deceased donor (DD) Tx (n=41,424) performed during the same period.

Results: Of 111 OPTN/UNOS KPD tx, 103 (92.8%) kidneys were shipped, 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. This compared to all other KPD programs shipped kidneys with a DGF of 4,1%, shipped distances 0 to >2000 miles. GS at 6 months for all 111 OPTN/UNOS KPD tx (98.0%) was statistically no different from other KPD tx (97.8%, p=0.59) and directed LD tx (98.1%, p=0.30) but significantly better than DD Tx (95.1%, p < .01).

Conclusions: The safety of shipped LDK has been shown in KPD with DGF and early GS of these kidneys statistically no different than locally retrieved and Tx LDKs and better than DD Tx. The well established and widely adopted (>60% of all LD transplant programs participate) processes utilized in KPD could be adapted more broadly to allow biologically compatible but geographically distant donor/recipient pairs to overcome the major financial and logistic barriers limiting these LDTx opportunities. As this can have a significant effect on transplant rate and organ availability, the transplant community should examine national collaboration to facilitate these LD opportunities.

CITATION INFORMATION: Aeder M, Leishman R, Stewart D. Removing Geographic and Financial Barriers for Directed Living Kidney Donations: Lessons from Kidney Paired Donation. Am J Transplant. 2016;16 (suppl 3).

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