*Purpose: The OPTN Kidney Paired Donation Pilot Program (KPDPP) is a national KPD system that has served the kidney transplant community for over 10 years. We aim to summarize the first 10 years of the OPTN KPDPP.

*Methods: Summary statistics, match success rates and two-year unadjusted graft and patient survival analysis were calculated using OPTN data as well as data on candidate/donor pairs that entered OPTN KPDPP from 10/01/10-12/31/20. Unadjusted Kaplan Meier methods were used to estimate graft and patient survival.

*Results: Over the past 10 years, 124 out of 215 (58%) of currently active kidney programs have participated in the OPTN KPDPP by entering at least one pair for matching. On average, 249 candidates were added to the program annually, with over 4,000 match offers sent during this time. The majority of matches identified were 3-way exchanges (50%). OPTN KPDPP has facilitated in total 366 transplants; the match success rate has remained around 10% since 2016 (Fig 1). Increases in the match success rates were seen immediately following the implementation of distinct system wide improvements to the program, such as prescreen reminder emails and histocompatibility policy changes. The two-year unadjusted graft and patient survival rates were 93.4% and 96.4% respectively (Fig 2a-b). After adjusting for multiple comparisons, two-year outcomes in the OPTN KPDPP did not significantly differ from the outcomes of other living and deceased donor transplants.

*Conclusions: Although a pilot program, over its 10-year legacy the OPTN KPDPP has created a transplant pathway for patients with willing but incompatible living donors. The outcomes of the program have been consistent with other manners of transplant. Through the discord provided by OPTN committees and public comment, the OPTN KPDPP will continue to provide additional transplant opportunities for candidates with incompatible living donors.

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