Although the number of living donor paired exchange (LDPE) kidney transplants increased 1000 fold between 2005-10, the total number of living donor kidney transplants (LDTx) declined by 4% in the United States. The purpose of this analysis was to determine the association between center participation in LDPE and the percent change in LDTx per year during the study period.

SRTR data were used to identify transplant centers performing ≥ 60 LDTx during the period 2005-2010 (n = 156 centers).

The median number of LDPE transplants per center was 5 range (0-116), n = 16 centers performed zero LDPE transplants, while n = 24 centers had ≥ 10% of their LDTx volume from LDPE and were considered high use LDPE centers. The table shows that in high use LDPE centers LDTx accounted for 36% of transplants performed during the study period, a percentage not dissimilar to that in centers with lower use of LDPE.

The figure shows the percent LDPE/LDTx in each center on the x-axis versus the annual percent change in LDTx per year (2005-2010) on the y axis. There was no clear association between use of LDPE and yearly percent increase in LDTx at the center level. Among the n =24 high LDPE users (circles) only n = 8 (33%) had an increase in LDTx.

We conclude that participation in LDPE is not associated with an increase in LDTX at the center level. The inability of most high use LDPE centers to increase the total number of living donor transplant numbers suggests the importance of center level factors. A comparison of the organization and resources between high use LDPE centers that did (i.e. Center A in Figure) and did not (i.e. center B, Figure) increase LDTx may provide useful insights that will enable centers to recognize the potential benefits of participation in LDPE.

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