Early Outcomes of Transplant Recipients in the OPTN Kidney Paired Donation Pilot Program Mark Aeder, MD, University Hospitals Case Med Center Darren Stewart, MS, UNOS Ruthanne Leishman, RN, MPH UNOS Tuomas Sandholm, PhD, Carnegie Mellon University Richard Formica, MD, Yale University

None of the authors of this abstract have any financial relationships to declare relative to the materials presented. Disclosures

 The KPD Pilot Program was late to the KPD arena as the proposal released for public comment in 2006, Board approved in 2008, and performed the first transplant in  Reached the “tipping point” in national participation  Now have the opportunity to present early outcomes Background

OPTN KPDPP Transplants As of July 24: 110 transplants

 Chains and 3-way exchanges comprised 90% of the transplants Paired Transplants

EthnicityOPTN/UNOS KPDPP Listing (904)# OPTN/UNOS KPDPP Tx (88)# National Living Donor Tx* (23,401) National New Kidney Listings* (145,413) National All DD Tx* (67,097) White69%65%66%46%44% AA15%21%13%29%32% Hispanic10%3%14%17%16% Asian5%6%5%7%6% Transplants by Ethnicity # - Through 3/31/14 * - Aggregate 1/1/ /31/2013

Time Waiting following Listing for KPDPP Transplant Recipients

Outcomes after Being Added to KPD System After 1 year, about half are still waiting; 43% transplanted by OPTN KPDPP or other means.

Expanding Access

 From 10/2010 through 2/2014, 83 KPD transplant were facilitated through the OPTN KPDPP  During this time, 19,028 other living donor (LD) and 34,709 deceased donor (DD) were performed  6 month outcomes were reviewed on these cohorts with regard to key outcomes  KPD transplants outside of pilot program identified by living donor relationship reported as “paired donation” Data/Methods

Kidneys ShippedDonor Traveled for Donation Donor and Recipient at Same Hospital 75 (90.4%)2 (2.4%)6 (7.2%) Shipping of Kidneys in OPTN KPDPP

N=1 N=2 N=3 N=1 N=6 N=1 N=2 N=3 N=1 N=2 N=1 Inter-regional Shipping (to Regions 1, 2,3) 73% (n=61) kidneys shipped inter-regionally. Frequent flyer miles: 4,174 10,68216,191

N=1 N=3 N=1 N=2 N=1 Inter-regional Shipping (to Regions 4, 5, 6, 7) Frequent flyer miles: 22,06123,75829,46837,189

N=2 N=1 N=2 N=1 N=2 N=1 Total of 40 different inter-regional combinations have occurred (1  2, 2  1, 2  7, 4  3, etc). Inter-regional Shipping (to Regions 8 – 11) Frequent flyer miles: 40,53941,71443,13144,752

Transplant Type# TransplantsMedian CIT (hr)% DGF% GS (6 mo) KM OPTN KPDPP Other LD KTx19, DD Tx34, Outcomes Summary Non-OPTN KPD1,

Early Graft Survival

 Over 90% of the shared kidneys were shipped from the donor to the recipient center with a median CIT of 8 hours  Despite the longer CIT, DGF was equitant with the national cohort of LD transplants (2.4%) and less than DD tx 24.8%  The distribution of KPDPP recipients was relatively similar to the candidate entry into the program. One notable exception is that AA recipients represented 21% of the recipients (compared to 13% for all LD) Summary

 KPDPP Initial 6 month graft survival (98.8%) was equivalent to all LD graft survival (98.1%) and improved compared to DD transplant recipients (95.1%)  Although time to listing in the KPDPP was over 500 days from initial transplant listing, the median time to transplant for the recipients was 187 days and over 80% of the transplanted recipients waited less than a year Summary

 The KPDPP has proved excellent 6 month outcomes that are comparable to the entire national LD recipient population  Shipping kidneys in the KPDPP, despite longer CIT, does not appear to have a detrimental effect on outcomes  All patients with a willing but incompatible living donor should be offered an early opportunity to be listed as a donor-recipient pair in the OPTN/UNOS KPDPP Conclusion