TY - JOUR
T1 - Favourable Living Donor Kidney Transplantation Outcomes within a National Kidney Exchange Program
T2 - A Propensity Score Matching Analysis
AU - van de Laar, Stijn C
AU - de Weerd, Annelies E
AU - Bemelman, Frederike J
AU - Idu, Mirza M
AU - de Vries, Aiko P J
AU - Alwayn, Ian P J
AU - Berger, Stefan P
AU - Pol, Robert A
AU - van Zuilen, Arjan D
AU - Toorop, Raechel J
AU - Hilbrands, Luuk B
AU - Poyck, Paul P
AU - Christiaans, Maarten H L
AU - van Laanen, Jorinde H H
AU - van de Wetering, Jacqueline
AU - Kimenai, Hendrikus J A N
AU - Reinders, Marlies E J
AU - Porte, Robert J
AU - Dor, Frank J M F
AU - Minnee, Robert C
N1 - Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.
PY - 2025/1/29
Y1 - 2025/1/29
N2 - BACKGROUND: KEPs (kidney exchange programs) facilitate living donor kidney transplantations (LDKT) for patients with incompatible donors, who are typically higher risk than non-KEP patients because of higher sensitization and longer dialysis vintage. We conducted a comparative analysis of graft outcomes and risk factors for both KEP and non-KEP living donor kidney transplants.METHODS: All LDKTs performed in the Netherlands between 2004-2021 were included. The primary outcome measures were one-, five- and 10-year death censored graft survival (DCGS). The secondary outcome measures were delayed graft function (DGF), graft function, rejection rates and patient survival. We used a propensity score matching model to account for differences at baseline.RESULTS: Out of 7536 LDKTs, 694 (9%) were transplanted via the KEP. Ten-year graft survival was similar for KEP 0.916 (95% CI: 0.894 - 0.939) and non-KEP 0.919 (0.912 - 0.926, p = 0.82). We observed significant differences in five-year rejection (12% vs 7%), and five-year patient survival (KEP: 84%, non-KEP: 90%), which was non-significant after propensity score matching. Significant risk factors for lower graft survival included high donor age, re-transplantations, extended dialysis vintage, higher panel reactive antibodies, and nephrotic syndrome as the cause of end-stage kidney disease .CONCLUSIONS: Transplantation via KEP offers a viable alternative for patients lacking compatible donors, avoiding specific and invasive pre- and post-transplant treatments. KEP's similar survival rate to non-KEP suggests prioritizing KEP LDKT over deceased donor kidney transplantation, desensitization, and dialysis. However, clinicians should consider the identified risk factors when planning and managing pre- and post-transplant care to enhance patient outcomes. Thus, we advocate for the broad adoption of KEP and establishment in regions lacking such programs, alongside initiation and expansion of international collaborations.
AB - BACKGROUND: KEPs (kidney exchange programs) facilitate living donor kidney transplantations (LDKT) for patients with incompatible donors, who are typically higher risk than non-KEP patients because of higher sensitization and longer dialysis vintage. We conducted a comparative analysis of graft outcomes and risk factors for both KEP and non-KEP living donor kidney transplants.METHODS: All LDKTs performed in the Netherlands between 2004-2021 were included. The primary outcome measures were one-, five- and 10-year death censored graft survival (DCGS). The secondary outcome measures were delayed graft function (DGF), graft function, rejection rates and patient survival. We used a propensity score matching model to account for differences at baseline.RESULTS: Out of 7536 LDKTs, 694 (9%) were transplanted via the KEP. Ten-year graft survival was similar for KEP 0.916 (95% CI: 0.894 - 0.939) and non-KEP 0.919 (0.912 - 0.926, p = 0.82). We observed significant differences in five-year rejection (12% vs 7%), and five-year patient survival (KEP: 84%, non-KEP: 90%), which was non-significant after propensity score matching. Significant risk factors for lower graft survival included high donor age, re-transplantations, extended dialysis vintage, higher panel reactive antibodies, and nephrotic syndrome as the cause of end-stage kidney disease .CONCLUSIONS: Transplantation via KEP offers a viable alternative for patients lacking compatible donors, avoiding specific and invasive pre- and post-transplant treatments. KEP's similar survival rate to non-KEP suggests prioritizing KEP LDKT over deceased donor kidney transplantation, desensitization, and dialysis. However, clinicians should consider the identified risk factors when planning and managing pre- and post-transplant care to enhance patient outcomes. Thus, we advocate for the broad adoption of KEP and establishment in regions lacking such programs, alongside initiation and expansion of international collaborations.
U2 - 10.2215/CJN.0000000611
DO - 10.2215/CJN.0000000611
M3 - Article
C2 - 39879095
SN - 1555-9041
JO - Clinical journal of the American Society of Nephrology : CJASN
JF - Clinical journal of the American Society of Nephrology : CJASN
ER -