The growing role of kidney exchange in the U.S.

 Here's a paper accepted for publication in the American Journal of Transplantation, tracing the growing role of kidney exchange in the U.S. (But much remains to be done...)

Temporal Trends in Kidney Paired Donation in the United States: 2006 – 2021 UNOS/OPTN Database Analysis  by Neetika Garg, MD, Carrie Thiessen, MD, PhD, Peter P. Reese, MD, PhD, Matthew Cooper, MD, Ruthanne Leishman, RN, MPH, John Friedewald, MD, Asif A. Sharfuddin, MD, Angie G. Nishio Lucar, MD, Darshana M. Dadhania, MD, MS, Vineeta Kumar, MD, Amy D. Waterman, PhD, Didier A. Mandelbrot, MD  PII: S1600-6135(23)00694-9 DOI: https://doi.org/10.1016/j.ajt.2023.09.006 To appear in: American Journal of Transplantation

Abstract:  Kidney paired donation (KPD) is a major innovation that is changing the landscape of kidney transplantation in the United States. We used the 2006 - 2021 United Network for Organ Sharing data to examine trends over time. KPD is increasing, with one in 5 living donor kidney transplants (LDKT) in 2021 facilitated by KPD. The proportion of LDKT performed via KPD was comparable for non-Whites and Whites. An increasing proportion of KPD transplants is going to non-Whites. End-chain recipients are not identified in the database. To what extent these trends reflect how end-chain kidneys are allocated, as opposed to increase in living donation among minorities, remains unclear. Half the LDKT in 2021 in sensitized (PRA ≥80%) and highly sensitized (PRA ≥98%) groups occurred via KPD. Yet, the proportion of KPD transplants performed in sensitized recipients has declined since 2013, likely due to changes in the deceased donor allocation policies and newer KPD strategies such as compatible KPD. In 2021, 40% of the programs reported not performing any KPD transplants. Our study highlights the need for understanding barriers to pursuing and expanding KPD at the center level, and the need for more detailed and accurate data collection at the national level.