Single-Center Experience of Paired Kidney Exchange: Effects On Outcomes With Variable Shipping Distance and Cold Ischemic Time.

Abstract

Background: National paired kidney exchange programs benefit patients, but there is a paucity of data on the impact of cold ischemic time (CIT) and shipping distance on transplant outcomes. Methods: This is a single-center study examining outcomes of 53 consecutive cases of paired kidney exchange (2011-2014). One-year actuarial survival rates were determined by Kaplan-Meier analyses. Results: Recipients of paired kidney exchanges received grafts either from our center (n=13, 24.5%) or were shipped from an outside hospital (n=40, 74.5%). For shipped kidneys, the average CIT was 12.5 h (±3.9 h), and the average distance shipped was 1045 mi (±465 mi). Kaplan-Meier one-year actuarial graft survival rates were not statistically different between shipped and non-shipped kidneys, 92% vs 90%, p=0.96, Figure 1. The rate of DGF for shipped kidneys was 10% (4/40) vs 0% (0/13) for non-shipped NKR kidneys (p=0.25). Multivariate analyses controlling for donor age, PRA, HLA match did not demonstrate a statistically significant association between DGF and CIT (p=0.11) and distance shipped (p=0.17). However, the one-year actuarial graft survival rates of kidneys with and without DGF were, 50% and 95.0%, respectively (p=0.01), Figure 2. Conclusions: A statistically insignificant, but clinically significant rate of DGF was observed in living donor kidneys received from external programs. This risk of DGF was not related to CIT and shipping distance in a multivariate analysis. Importantly, DGF was found to be associated with diminished 1-year kidney graft survival. Further study is needed to fully determine the impact of distance and CIT on outcomes of transplants in national paired exchange programs.Figure: No Caption available.Figure: No Caption available.