Utilization and outcomes of kidney paired donation in the United States

Background. Kidney paired donation (KPD) offers the best transplant option for patients with incompatible live kidney donors. Although studies suggest substantial expansion of the donor pool if fully used, few patients in the United States have undergone KPD. Methods. We analyzed the 209 KPD and 89 list paired donation (LPD) transplants reported to United Network for Organ Sharing to better understand access to these modalities, clinical outcomes, and areas of potential expansion. Results. Although many centers offer KPD/LPD, most centers have performed no more than a handful of transplants. As expected, outcomes with KPD/LPD were equivalent to direct donation matched controls. In analyzing current practice, we identified two limitations to KPD in its current use. First, KPD is likely limited now by benefiting mostly patients who are easy to identify and match (such as A donors with B recipients or B donors with A recipients). Second, although some expansion of local KPD availability has reduced travel requirements for patients in those areas, significant room for growth remains. Conclusions. Our results suggest that full utilization of KPD would encourage registration of and improve matching for patients who are more difficult to identify and match (Such as highly sensitized recipients). Furthermore, expansion of KPD would likely reduce travel requirements and thereby improve access to this treatment modality.