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 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
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
SN - 1600-6135
VL - 18
SP - 2791
EP - 2797
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -