Kidney donors can develop ESRD after donation, but the outcomes of those who do remain poorly characterized.

Methods: Using USRDS and SRTR data, we compared access to kidney transplantation (KT), time from ESRD to listing, time from listing to KT, and post-KT graft failure and death between donors and matched nondonors with ESRD.

Results: Among 99 individuals who donated a kidney between April 1994 and November 2011 and who developed ESRD, 78 initially received dialysis (of whom 37 listed for KT, 2 received live donor KT without listing, and 39 never listed for or received a KT), 20 listed preemptively (of whom 19 were subsequently transplanted), and 1 received a preemptive live donor KT without listing or ever receiving dialysis (Figure 1). Donors were listed earlier (median-time-to-listing 17 months versus 120 for nondonors; p<0.001), received KT earlier (median-waiting-time 2.8 months versus 21.5 for nondonors; p<0.001) (Figure 2), and received 13% live donor, 87% standard criteria, and 0% expanded criteria deceased donor KT (versus 39%, 50%, and 11% in nondonors). Post-KT graft (HR 1.1, p=0.7) and patient (HR 0.6, p=0.5) survival were comparable in donors and matched nondonors.

Conclusions: Live donors who developed ESRD were listed and transplanted faster than their matched nondonor counterparts, with equivalent post-transplant outcomes. However, our finding that 39% of donors who developed ESRD never listed for a transplant is tragic and strongly warrants improvements in access to transplantation for such donors.

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