title: Kidney transplant outcomes for prior living organ donors.
abstract: The Organ Procurement and Transplantation Network gives priority in kidney allocation to prior live organ donors who require a kidney transplant. In this study, we analyzed the effect of this policy on facilitating access to transplantation for prior donors who were wait-listed for kidney transplantation in the United States. Using 1:1 propensity score-matching methods, we assembled two matched cohorts. The first cohort consisted of prior organ donors and matched nondonors who were wait-listed during the years 1996-2010. The second cohort consisted of prior organ donors and matched nondonors who underwent deceased donor kidney transplantation. During the study period, there were 385,498 listings for kidney transplantation, 252 of which were prior donors. Most prior donors required dialysis by the time of listing (64% versus 69% among matched candidates; P=0.24). Compared with matched nondonors, prior donors had a higher rate of deceased donor transplant (85% versus 33%; P<0.001) and a lower median time to transplantation (145 versus 1607 days; P<0.001). Prior donors received higher-quality allografts (median kidney donor risk index 0.67 versus 0.90 for nondonors; P<0.001) and experienced lower post-transplant mortality (hazard ratio, 0.19; 95% confidence interval, 0.08 to 0.46; P<0.001) than matched nondonors. In conclusion, these data suggest that prior organ donors experience brief waiting time for kidney transplant and receive excellent-quality kidneys, but most need pretransplant dialysis. Individuals who are considering live organ donation should be provided with this information because this allocation priority will remain in place under the new US kidney allocation system.
authors.affiliation: Department of Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania;
authors.forename: Vishnu
authors.initials: V
authors.lastname: Potluri
authors.affiliation: Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, Department of Biostatistics and Epidemiology, and.
authors.forename: Meera N
authors.initials: MN
authors.lastname: Harhay
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: F Perry
authors.initials: FP
authors.lastname: Wilson
authors.affiliation: Renal-Electrolyte and Hypertension Division, Perelman School of Medicine.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.affiliation: Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, Department of Biostatistics and Epidemiology, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and peter.reese@uphs.upenn.edu.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score
keywords: epidemiology; kidney transplantation; live donors; outcomes