TY - JOUR
T1 - Temporal changes in the composition of a large multicenter kidney exchange clearinghouse
T2 - Do the hard-to-match accumulate?
AU - Holscher, Courtenay M.
AU - Jackson, Kyle
AU - Thomas, Alvin G.
AU - Haugen, Christine E.
AU - DiBrito, Sandra R.
AU - Covarrubias, Karina
AU - Gentry, Sommer E.
AU - Ronin, Matthew
AU - Waterman, Amy D.
AU - Massie, Allan B.
AU - Garonzik Wang, Jacqueline
AU - Segev, Dorry L.
N1 - Funding Information:
The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the US Government. Funding for this study was pro‐ vided in part by the National Kidney Registry (NKR). This work was supported by grant numbers F32DK109662 (Holscher), F32DK113719 (Jackson), F32DK105600 (DiBrito), K01DK101677 (Massie), K24DK101828 (Segev), and R01DK098431 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases, grant number F32AG053025 (Haugen) from the National Institute on Aging, and by an American College of Surgeons Resident Research Scholarship (Holscher).
Funding Information:
The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the US Government. Funding for this study was provided in part by the National Kidney Registry (NKR). This work was supported by grant numbers F32DK109662 (Holscher), F32DK113719 (Jackson), F32DK105600 (DiBrito), K01DK101677 (Massie), K24DK101828 (Segev), and R01DK098431 (Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases, grant number F32AG053025 (Haugen) from the National Institute on Aging, and by an American College of Surgeons Resident Research Scholarship (Holscher).
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/11
Y1 - 2018/11
N2 - One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P =.03), the proportion decreased to 17% by June 2016 (P <.001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P =.02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
AB - One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P =.03), the proportion decreased to 17% by June 2016 (P <.001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P =.02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
KW - donors and donation: living
KW - donors and donation: paired exchange
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
KW - sensitization
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U2 - 10.1111/ajt.15046
DO - 10.1111/ajt.15046
M3 - Article
C2 - 30063811
AN - SCOPUS:85053407344
VL - 18
SP - 2791
EP - 2797
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 11
ER -