Introduction: Kidney paired donation (KPD) programs provide the possibility of ABO compatible or negative crossmatch transplants for recipients whose original donor was incompatible. The goal of this study was to examine the outcomes of kidneys shipped via commercial air in an integrated KPD program.

Methods: We retrospectively reviewed all transplants from our two-site kidney paired donor program between 2007 and 2012. Graft survival, total ischemic time, delayed graft function (dialysis within the first week), slow graft function (serum creatinine decrease less than 50% in first 48 hours), eGFR (MDRD) and kidney biopsies were reviewed.

Results: 88 paired donor transplants were performed, including 23 (26.1%) kidneys shipped via commercial air between 2 US cities (3+ hours flight time). The median follow up was 18 months (1-62 months). During this period, 26 kidney transplant chains were created and 6 non-directed donors were involved. The mean ischemic time for shipped kidney allografts was significantly longer than for kidneys transplanted locally (see Table). However, implantation biopsies in this group did not show acute tubular necrosis in any of the kidneys. eGFR at 1 month post-transplant and overall graft survival were similar. A higher proportion of shipped kidneys experienced slow graft function but the difference was not statistically significant. Delayed graft function did not occur in either group. One shipped kidney was lost early due to technical complications unrelated to the ischemic time.

Conclusions: Living donor kidneys shipped to a recipient hospital via commercial air have outcomes similar to those transplanted locally in our KPD program. Including geographically separate transplant centers helps to maximize the application of KPD.

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