Evaluation of Whether Kidney Paired Donations Improve Overall Transplant Center Performance.

Abstract

Increasing living-donor kidney transplant procedures via kidney paired donations could help combat organ shortages. We examined whether a higher volume of kidney paired donation transplants would lead to increased center performance. Kidney paired donation, living-donor, and deceased-donor transplant data from 165 centers between 2012 and 2016 were obtained from the UNOS OPTN database. The fixed-effects model was used for panel analysis based on Durbin-Wu-Hausman tests (P < .001). Regression analyses tested associations between total transplant number and kidney paired donation-to-living donor kidney transplant ratio, incorporating up to 2-year lag terms. Regression analyses also tested associations between number of new wait list registrations and kidney paired donation transplant ratio. Mean and median number of kidney paired donor transplants equaled 3.59 and 1.2, respectively. Only 5 centers performed > 20 paired donation transplants annually. Mean and median ratios of paired donation transplants were 0.54 and 0.11. Total transplant number was not associated with paired donation transplant ratio of the same year (b= -.425, P = .662) or with that of 2 prior years (P = .830 and P = .629, respectively). Similarly, new wait list registrations were not correlated with paired donation transplant ratio of the same year (P= .501, P = .851) or that of 2 prior years (P = .792 and P = .816, respectively). When transplant centers were divided into those performing ≥ 10 paired donation trans-plants annually (18 transplant center, n = 90) versus those performing < 10 annually (147 transplant center, n = 735), no significant effects were shown (P > .10). Kidney paired donation transplant does not appear to affect transplant center performance. This may be due to the small volume of these transplants currently performed by centers, thereby limiting overall growth in the number of transplants and new registrations.