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Paired-Donor Kidney Exchange Has Comparable Early Graft Function to Directed Living Donor

E. McCracken, A. Sites, B. Rawashdeh, A. Nishio-Lucar, A. Agarwal

Transplant Surgery, University of Virginia, Charlottesville, VA

Meeting: 2020 American Transplant Congress

Abstract number: A-025

Keywords: Donors, unrelated, Graft function, Ischemia, Kidney transplantation

Session Information

Session Name: Poster Session A: Kidney Paired Exchange

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Living kidney donation in the United States is associated with improved graft and patient survival. However, there is minimal data on graft function in paired-donor exchange, despite the concerns for compromised function from increased cold ischemia time.

*Methods: A single-center, retrospective review compared 14 paired-donor recipients (PDR) to 124 living-donor recipients (LDR) transplanted from 12/2013 to 6/2019. All recipients received T-cell depletion induction and triple-agent immunosuppression. Univariate analysis compared demographics and multivariate linear regression compared glomerular filtration rate (GFR) at 6 and 36 months after transplant. Covariates included gender, age, race, BMI, diabetes, days on dialysis, preemptive transplant, cold ischemia time, and delayed graft function. Kaplan-Meier and log-rank analysis was performed on allograft and recipient survival.

*Results: Patient and graft survival were 100% in PDR and 98% in LDR (p=0.6). Mean follow-up was 39+22.7 and 33+17.3 months (p = 0.238). Mean cold time was significantly longer for PDR (545.6+287.6min vs 54.0+77.3min, p<0.0001). Delayed graft function was similar (7% in PDR vs 0%, p = 0.185), as was mean estimated post-transplant survival score (30+27% in PDR vs 34+26%, p=0.856). There was no significant difference in demographics (majority of patients were white, male, and older than 45 years). Mean GFR at 6 months was 52.2+17.5mL/min in PDR and 60+19.0 in LDR (coeff = -7.79, CI -18.69-3.105, p = 0.160). At 36 months, mean GFR was 58.3+19.1 in PDR and 64.9+19.4 in LDR (coeff = -6.55, CI -23.57-10.47, p = 0.443). Univariate linear regression comparing GFR at 6 months revealed no significant difference between cohorts (coeff = -4.25 CI -13.0-4.47, p = 0.34). Nor was there a significant difference at 36 months (coeff = 1.43 CI -4.07-6.94, p = 0.61). This equivalency held when multiple confounders were controlled for by mulivariate regression (coeff = 0.319 CI -14.51-15.15, p = 0.97).

*Conclusions: Our findings confirm similar early outcomes between PDR and LDR, further supporting kidney paired-donor utilization. GFR was no different at 6 or 36 months despite longer cold ischemia time in PDR. Long-term follow-up studies are needed to validate these findings.

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To cite this abstract in AMA style:

McCracken E, Sites A, Rawashdeh B, Nishio-Lucar A, Agarwal A. Paired-Donor Kidney Exchange Has Comparable Early Graft Function to Directed Living Donor [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/paired-donor-kidney-exchange-has-comparable-early-graft-function-to-directed-living-donor/. Accessed May 16, 2025.

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