a message from kidney paired donation (kpd) work group · 2016. 5. 16. · centersto enter ndds...

A Message from Kidney Paired Donation (KPD) Work GroupWe are pleased to present this report to the transplant community and welcome the opportunity to share information and results of the OPTN/UNOS Kidney Paired Donation Pilot Program (KPDPP). The vision ofthe program is that every kidney transplant candidate with an incompatible but willing and approved living donor receives a living donor kidney transplant. To that end, the first match run was conducted in late 2010. Through March 31, 2014, 88 patients have received a lifesaving kidney transplant through the program. In 2013 alone, 52 patients were transplanted, a 246% increase over the previous high of 15 in 2011.

Figure 1. OPTN/UNOS KPDPP Transplants per Year

Num

ber o

f Tra

nspl

ants

60

2

15 10

52 50

40

30

20

10

0

Year of Transplant

2010 2011 2012 2013

It is particularly encouraging to see that the KPDPP has increased transplant opportunities for candidates who tend to have difficulty finding a match on the deceased donor waiting list. More than a quarter of thecandidates who received a kidney through the program had a calculated panel reactive antibody (CPRA) of 80% or higher (page 7), including 15 recipients with a CPRA of at least 95%. In addition, nearly 300 minoritycandidates have participated in KPDPP match runs, and minorities comprise one third of KPDPP transplant recipients (page 6).

We appreciate the dedicated transplant teams at 138 kidney programs (61% of the U.S. living donor kidney programs) who have agreed to participate in the KPDPP (page 4). We especially appreciate the hundreds of individuals who have contributed their expertise, time and attention to improving the program by servingon committees, finding solutions to problems and providing valuable feedback in surveys. Most importantly, we owe a debt of gratitude to the living donors who are willing to donate a kidney to a loved one, friend or someone they don’t even know. They are the heroes that save lives.

The State of the OPTN/UNOS KPD Pilot Program 2

During the past three years, we developed an increasingly userfriendly, online KPD system that is integrated with UNetSM, the computer system that manages the deceased donor waiting list. Candidate and donor dataare shared among transplant centers to facilitate kidney exchanges, allowing users to view and respond to match offers and to see the donor information in one place. We continue to solicit and respond to user recommendations to make further system improvements.

The program was originally governed solely by operational guidelines. The first KPDPP policies were approved by the OPTN/UNOS Board of Directors in November 2012 and implemented in February 2013. At that time, many of the operational guidelines were converted to policy. The KPD Work Group, under the OPTN/UNOS Kidney Transplantation Committee, continues this conversion, with several policy proposals planned for 2014 and 2015. The program will be governed by both policy and operational guidelines until the transition is complete.

Several subcommittees have worked to improve KPDPP processes:• The Finance Subcommittee developed financial tools to help transplant hospitals work through billing and paying for a KPD kidney that is recovered at one institution and transplanted at another. The tools include financial recommendations, a template contract and a financial checklist.

• The Histocompatibility Advisory Subcommittee developed KPD histocompatibility policies to improve theKPD system by decreasing the match offer decline rate related to unacceptable antigens. They routinelyreview the decline reasons related to HLA antibodies and continuously evaluate the policies to promote process improvement.

• The Design and Optimization Algorithm Subcommittee is evaluating alternative matching algorithms to optimize match pair efficiencies in order to increase the number of transplants. The subcommittee also ensures that both easy and difficulttomatch patients have access to matching opportunities.

To assist potential donors and candidates who are considering KPD as an option, we are creating educational videos and expanding online resources for patients, donors and transplant professionals.

We welcome the remaining living donor kidney transplant hospitals to participate in the KPDPP and to suggest system improvements to optimize all aspects of the program. We look forward to continuing to help

transplant candidates receive the gift of life through kidney paired donation.

Sincerely on behalf of the OPTN/UNOS KPD Work Group, Mark Aeder, M.D.

Chair


Of the 228 active U. S. kidney program s approved to perform living donor transplants in the U.S., 138 (61%) have agreed to participate in the KPDPP, and 98 centers have entered at least one donor/candidate pair into a match run (Figure 2A). In early 2010, an initial wave of 69 transplant programs agreed to participate by way of four coordinating centers, central hubs that provided data directly to UNOS to operate the program. Fifteen “early adopter” programs provided data on a total of 43 pairs that were included in the very first match run on October 28, 2010, leading to matching opportunities for seven patients. By mid2011, a “critical mass” of 45 centers had entered match runeligible pairs into the system, resulting in a pool of well over 100 donors and candidates in each match run. Since then the number of candidates entered has steadily increased (page 7).

Participating Tra nsplant Programs1

Figure 2A: Trends in Participation— as of March 21, 2014

150

Oct 20101st match run

Num

ber o

f Kid

ney

Tran

spla

nt P

rogr

ams

March 2014110th match run

112

1/2010 7/2010 1/2011 7/2011 1/2012 1/2014 1/2013 7/2012 7/2013

15

69

98

138 Programs signedagreement to participate

Programs with eligiblepair(s) for match run

Critical mass

Early adopters

74

45

82

50

100

0

1 Includes all kidney transplant programs with active OPTN membership status, active living donor program status and active deceased kidney program status, as of March 21, 2014.


Num

ber o

f Mat

ch-R

un E

ligib

le C

andi

date

s Ent

ered

85 .......................

..................................

80

70

60 53

50

40

..............................................................................................

........ 30

20

90

........ 8 programs have entered 39% of KPD candidates

Half of participatingprograms have entered atleast 6 eligible candidates ..........

11

10 6

2 1

0

1 98

The number of candidates entered into the system varies greatly among participating hospitals. Since 2010, one program has entered 85 match runeligible candidates (along with their paired donors), or 9% of the total of 904 match runeligible candidates. The eight most actively participating programs account for 39% of the total number of candidates entered, while half of participating programs have entered at least six candidates (Figure 2B).

As the KPD Work group continues to encourage additional living kidney donor programs to join the pilot program, it also seeks ways to incentivize programs to enter all of their candidate/donor pairs, not justhardtomatch pairs, to create more matching opportunities for all participants.

Figure 2B: Number of match RunE ligible Candidates2 per Program — as of March 21, 2014

Transplant Program

2 A candidate can be entered into the KPDPP without being match run eligible. To be match run eligible, a candidate must have all required data elements entered and be set to “active” status in the KPD system.


Figure 3: Number of Candidates Added, by Month — through March 31, 2014

Candidates and Donors Added to the KPD SystemOn average, 25.2 candidates were added to the program each month since October 2010. In the first quarterof 2014, there has been an average monthly addition of over 28, reflecting the continued growth of the KPDPP. In total, 1,046 candidates have been added as of March 31, 2014. A total of 1,135 donors3 have been added, including 52 nondirected donors (NDDs). A NDD is a donor who enters the program without a pairedcandidate, with the intent of starting a NDD chain.

50

Num

ber o

f Can

dida

tes A

dded

11

Average of 25.2candidates added

per month

38

27

44

40

30

20

10

0 9/2010 3/2011 9/2011 3/2012 8/2012 2/2013 8/2013 2/2014

Month Candidate Added

3 While most candidates entered the program with one paired donor, some candidates had more than one donor.


Figure 4: Average Number of E igib e Candidates and Donors per Match Runthrough March 31, 2014

Match Run ParticipationCoinciding with the steady growth in participating programs, the number of candidatedonor pairs eligible4 for each match run has increased dramatically since KPDPP initiation (Figure 4). In late 2010, the candidatedonor pool consisted of less than 50 pairs available for matching. By 2013, more than 200 candidates and donors were consistently entered into each weekly match run. In the first quarter of 2014, the numbers had grown to average247 donors and 235 candidates per match run, and a record 270 donors and 256 candidates wereincluded in the match run on April 21, 2014.

Despite the overall increasing trends, the number of nondirected donors (NDDs) eligible for match runs has declined in recent months. NDD chains are an especially powerful way to uncover matching opportunities for a large number of patients because chains operate in one direction, without requiring a match to “close the loop,” as in twoway and threeway exchanges. The KPD Work Group continues to explore ways to encourage centers to enter NDDs into the system, including providing the option of bridge donation. In bridge donation, apaired donor at the end of a chain can opt to become a nondirected donor in a future match run, turning ashort chain into a potentially much longer chain that will result in more patients receiving transplants (Figure 4).

l l —

Non

-dire

cted

Don

ors

Cand

idat

es a

nd D

onor

s

45 43

2

6 5.3

1 0.25

104

152 185

Candidates

Paired donors

Non-Directed donors

198

228

238 247

235

44

0

25

20

15

10

5

150

100

250

200

50

0

8/2010 2/2011 8/2011 2/2012 8/2012 2/2013 8/2013 2/2014

Match Run Date

4 To be match run eligible, a candidate must have all required data elements entered and be set to “active” status in the KPD system.


Figure 5A: Matches Found per Month

Trends in Matching OpportunitiesA growing pool of candidates and donors eligible for match runs (Figure 4), the introduction of nondirected donor (NDD) chains, and the switch in 2012 from monthly to weekly match runs have led to substantial increases in the number of donorcandidate matches found over time (Figure 5A). In March 2014, 47 matches were identified. Through the first quarter of 2014, an average of 44 match offers have been sent per month, a 22% increase over 2013. In response to member feedback, on June 2, 2014 the program started running the match twice per week on a trial basis. Since 2010, over 1,000 match offers have been sent to participating transplant programs.

100

7

26

40

27

Weeklymatch runs

2X/monthmatch runs

NDDchains

Monthlymatch runs

47

67

88 90

80

70

60

50

40

30

20

10

0

Mat

ches

- Per

Mon

th

System repair 5

10/2010 4/2011 10/2011 4/2012 10/2012 4/2013 10/2013 4/2014

Figure 5B: Matches Found by Exchange Type

2-way10%

3-way45%

Chain45%

Relatively few (10%) of the matches found in the KPDPP have been from twoway exchanges, while threeway exchanges (45%) and NDD chains (45%) have together accounted for the majority of matches (Figure 5B).

5 The generation of “input files” that are used by the algorithm that identifies all possible edges between compatible donors and candidates was implemented as part of UNet’s KPD application in early 2013. Previously, these input files were generated using a nonfully automated process (outside of UNet) that inadvertently led to fewer edges being drawn. Once this “manual” process was remedied, a bolus of matches that would likely have been identified previously was found all at once in November 2012.


Characteristics of Candidates and Transplant RecipientsNearly 70% of the 904 total KPDPP candidates have been white, 15% black, 10% Hispanic and 5% Asian. Therace/ethnicity distribution of the 88 KPDPP transplant recipients is fairly similar to that of candidates enteredinto the program, with 65% of recipients having been white (Figure 6A).

While nearly 60% of candidates have had blood type O, only 31% of recipients have had this most difficult tomatch blood type. Blood type O candidates tend to be more difficult to match since they are generally onlycompatible with other blood type O donors. Blood type B candidates are also often difficult to match. However,while blood type B candidates have represented only 15% of candidates, they have accounted for 24% of thetransplants facilitated thus far through the KPDPP (Figure 6A).

Figure 6A: Characteristics of Match Run-Eligible Candidates and Recipients(Blood Type, Race/Ethnicity)— through March 31, 2014

White65%

Asian6%Hispanic

3%

Recipient Race/Ethnicity (n=88)

Other/unk. 3%

White65%

Asian6%%Hispanic

3%

Recipient Race/Ethnicity (n=88)

Other/unk. 3%

White65%

Asian5%Hispanic

10%

Candidate Race/Ethnicity (n=904)

Other/unk. 1%

Black15%

Black21%

Recipient Blood Type (n=88)

O59%

Candidate Blood Type (n=904)

B15%

AB2%

A24% O

31%

B24%

AB5%

A40%

Transplant centers representing all 11 OPTN/UNOS regions have had candidates participate in OPTN/UNOSKPDPP match runs. Centers in Region 2 have contributed the most candidates (27%), followed by Region 7(14%) and Region 1 (12%). At least one of the 88 transplants performed thus far through the KPDPP have oc-curred in each region. (Figure 6B).


.

The averag e age 6 of the 904 participating candidates has been 47.3 years, with 3 Only 2% of the candidates have been pediatric.

Th

e age distri u

b

tion of patients program is fairly similar to the age distribution of participating candidates, altho percentage of the recipients (19.3%) compared to candidates (11.7%) have been

7.4%

in

th

e 506

4 age group.transplanted through the

Only 30% of KPD 7

ug

h a moderately hage 65 or

o

lder.

igher

Over a q

uart

er o

f

PP

cand

i

dat

es have had a CPRA of zero, whereas 46.2% have had CPRA of 80% or greater.

cand

id

ates

have be

en

x

e

tremel

y

n

e

si

s

t

iz

ed h v

, a i

n

g

a

CP

RA

o

f at

le

ast

98%

. Tho

u

g

h these patients are more difficult to match, 32% (n=28) of the transplants facilitated thus far have been for CPRA>80%patients and 17.1% (n=15) of recipients have had a CPRA of 95% or higher. Finding transplants for difficulttomatch patients is one of the goals of the KPDPP, and we are encouraged by these successes.

On average, can

didates hav

e waited 507 days (about 1 year and 4 months) on the deceased

before entering the KPDPP. The distribution of time on the deceased donor waitlist is fairly donor waimilar

its for

list8

candidates and recipients.

Figure 6B: Characteristics of Match RunEligible Candidates and Recipients(Region, Age, CPRA, Time on Deceased Donor Waitlist)— through March 31, 2014

OPTN Region

20%

27%

22%

13%

2%

10%

14%

9%

2% 5%

7%

2% 2% 5%

7%

15%

3% 3%

1 2 3 4 5 6 7 8 9 10 11

Candidates (n=904) Candidates (n=904)

30%

20%

10%

0%

Recipients (n=88)

12%

7% 7% 7%

Age

2.0% 0.0%

19.2%

14.8%

26.1%

37.4% 39.8%

11.7%

19.3%

29.7%

80%

Time on Deceased Waitlist Prior to Entering OPTN KPDPPAge

38.6%

30 1%

11.4% 12.5% 12.4%

2.3%

6.2%

12.5%

7.0% 7.2% 8.0%

25.8%

9.1%

17.0%

0% 1-49% 50-79% 80-89% 90-94% 95-97% 98-100%

40%

30%

10%

20%

0%

Recipients (n=88)

........................................................ ....

....

....

Candidates (n=904)

10.2% 7.5% 7.4%

5.0%

1.1% 4.5%

16.9%

10.0%

27.3%

22.7% 26.0%

6.8%5.9%

21.3%

9.1%

18.2%

1 to 2 >2 to 3 >3 to 5 >5days days days days years years years years

30%

10%

20%

0%

Recipients (n=88)

6 Candidate age as of first KPDPP match run; recipient age as of transplant date. 7 Candidate CPRA as of first KPDPP match run; recipient CPRA as of the match run that led to transplant or at time of WL removalfor chainclosing WL recipients.

8 Candidate and recipient time on WL = date candidate added to KPDPP minus date candidate added to WL; chainclosingrecipient time on WL = transplant date minus date candidate added to WL


KPDPP Participation by OPTN/UNOS RegionMore than one kidney transplant program from each of the 11 OPTN/UNOS regions have signed the agreement toparticipate in the KPDPP. All 14 programs in region 1, in fact, have signed up. Region 2 has entered 245 matchrun-eligible candidates into the system, more than any other region and over a quarter of the total number ofcandidates entered.

KPDPP transplants have occurred in all 11 regions. Centers in Region 2 have performed the most transplants(N=19, 22% of KPDPP transplants) followed by Region 1 (N=18, 20%). More than 75% of the 88 totaltransplants have resulted from interregional exchanges.

Figure 7: Participating Centers, Match Run-Eligible Candidates and Transplants byOPTN/UNOS Region — through March 31, 2014

11REGION

01REGION

10REGION

02REGION

09REGION

PUERTO RICO

07REGION

04REGION

06REGION

05REGION 08

REGION

03REGION

Region 1 Region 4 Region 7 Region 1014 (of 14) programs participating 19 (of 28) programs participating 17 (of 22) programs participating 12 (of 19) programs participatingN=105 KPDPP candidates (12%) N=62 KPDPP candidates (7%) N=131 KPDPP candidates (14%) N=62 KPDPP candidates (7%)N=18 KPDPP transplants (20%) N=6 KPDPP transplants (7%) N=13 KPDPP transplants (15%) N=4 KPDPP transplants (5%)

Region 2 Region 5 Region 8 Region 1121(of 30) programs participating 15 (of 30) programs participating 11 (of 18) programs participating 10 (of 22) programs participatingN=245 KPDPP candidates (27%) N=86 KPDPP candidates (10%) N=83 KPDPP candidates (9%) N=18 KPDPP candidates (2%)N=19 KPDPP transplants (22%) N=2 KPDPP transplants (2%) N=6 KPDPP transplants (7%) N=2 KPDPP transplants (2%)

Region 3 Region 6 Region 97 (of 22) programs participating 3 (of 9) programs participating 9 (of 13) programs participatingN=63 KPDPP candidates (7%) N=27 KPDPP candidates (3%) N=22 KPDPP candidates (2%)N=11 KPDPP transplants (13%) N=3 KPDPP transplants (3%) N=4 KPDPP transplants (5%)

Figure 7 Key# programs participating in KPDPP (of 228 total active living kidney donor programs)# KPDPP candidates (% of total 904 KPDPP candidates)# KPDPP transplants (% of total 88 KPDPP transplants)


Figure 8: Characteristics of Participating vs. Actua through March 31, 2014

TChhea rarc ae c/ te erist hnic

tics i ty di

of Pstribu

at ri oticip

ating vs n of ma t ch ru n

.e Ali gci btule a dlo Donno r s p

orartsi c ipating in

to the t

rib io

n

dis

ut of candidates

(shown pre

viousl

y in F

ig

the KPDPP (Figure 8) is very similarure 6A). About 70% of particip

ating

donor

s hav

e been white

and about 30% have been minorities. While 11% of the participating donors have been black, 18% of the don

ors that

a

ctuall

y dona

ted th

ro

ugh the KP

DPP h

ave

been b

lack

.

Bloo yp

d t e (Figure 6A In general,

s o

f p

articip

atin

g do

nors (F

ig

ure 8) a

re no

tabl

y d

ff

i

erent from

t

hos

e

of participating). While nearly 60% of candidates have had blood type O, only 34% of donors have hblood type O candidates are the mos

candidates

ad blood type O.

t dif

ficult

to ma

tch, s

inc

e they ar

e on

ly comp

atible with type O donors.

Type O d

onors are th

e easiest to match, since they are compatible with all blood types. However, despite the disproportion in blood type O donors and candidates, as well as the high percentage of candidates having a CPRA of

98%

or a

bo

ve (Figure 6B), the KDPPP still finds more than 40 matches per mon steadily growing participant pool (Figure 4).

Though only 17% of participating donors are blood type B donors, they have accounted for

th (Fig

u

re 5A) d

ue

to a

donations. Of the 435 participatin subtype. Though nonA1 donors

nearly a quarter of theg blood type A donors, 25 (5.7%) have been reported as having a nonA1 (e.g., “A2”)are compatible w

ith bloo

d

grou

p B and O c

didates,

a

n so far only nine candidates have been reported as both willing and medically eligible to receive nonA1 subtypecompatible match of f

ers.

l Donors—

Race/Ethnicity of Participating Race/Ethnicity of DonorsDonors (n=992) who Donated(n=88)

Asian

White71%

Asian3%Hispanic

7% Other/unk. 8%

Black11%

White73%

2% Other/unk. 2%

Black18%

Hispanic5%

Blood Type of ParticipatingDonors (n=992)

Blood Type of ParticipatingDonors (n=88)

O34%

A44%

AB

B17% O

33%

A40%

AB

B24%

5% 3%


Trends in Matching OpportunitiesThe annual number of transplants facilitated by the KPDPP surged to 52 in 2013 from 10 the prior year and a previous high of 15 in 2011 (Figure 9). Through the first three months of 2014, an additional 9 transplants have occurred, bringing the total since inception to 88.

Several factors contributed to the dramatic increase in 2013, including more matches found (Figure 5A), coupled with an improved match success rate. The match success rate— the percentage of match offers resulting in a transplant—was less than 3% for much of 2012 but jumped to 12% in 20139. To increase match success rates, an online tool that allows participating programs to “preaccept” or “prerefuse” donors that could potentiallymatch to their candidates was implemented in early 2013.

Common reasons for matches not resulting in a transplant include unacceptable donor antigens, unexpected positive crossmatches and the candidate being involved in an exchange through another KPD program. The KPD Work Group and its Histocompatibility Advisory Subcommittee continue to evaluate interventions that can increase the likelihood of matches becoming transplants.

Figure 9: Transplants in the KPDPP — through March 31, 2014

Date of Transplant

60

50

40 Total: 88 transplants

30

20

9 10

2 0

2010 2011 2012 2013 2014

10

52

15

(through March 31)

9 Based on KPDPP match runs from January 1, 2013 December 2, 2013.


gure 10A: T me to Transp ant (or Other Outcome ) for CandIncludes Match RunEligible Patients Added to the KPDPP from Jan 1, 2012 – Nov 22, 2013

Time to Transplant after Entering KPDPPFigure 10A shows outcomes for match runeligible candidates from 0 to 540 days after being added to the KPDPP. The cumulative percentage of candidates reaching each possible outcome by 12 and 18 months is highlighted.

By 18 months, 53% had received a transplant in one of four different ways: through the KPDPP (10%);through another KPD program (21%); from a nonKPD living donor transplant (11%); or from a deceased donor transplant (11%).

Less than 1% of patients were removed due to death, 11% were removed from the KPDPP for another reason,and 35% of candidates were still waiting for a transplant after 18 months.

Fi i l 10 11

idates Added to the KPDPP

Days since Patient Added to OPTN KPDPP

Out

com

e af

ter E

ntry

in O

PTN

/UN

OS

KPD

PP

Still w aitingin KPDPP

7%

1 9%

9%

9%

7%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

240 300 360

Transplanted in

KPDPP

Transplanted in ano

ther

KPD program

Other living donor tran

splant

Decea sed donor tr ansplant

R emo v ed for other r ea son

Death 0.5%

0%

At 12 months At 18 months

4 9%

3 5%

1 0%

2 1%

1 1%

1 1%

1 1%

0 60 120 180 420 480 540

10 Cumulative incidence curves shown in Figure 10A were derived using competing risks methodology for timetoevent data. 11 Based on OPTN KPDPP data as of November 30, 2013.


99 –11 80 0

99 –11 80 0

901–99

0811–

900721–

810630

–720541

–629451–

540271

–360

181–2709 –1 1

80n/a 1–90

40%

Perc

ent o

f Tra

nspl

ants

20%

14.8%

8.0%

(One year)

9.1%

3.4%

1.1% 1.1%

(Two years)

0.0%

2.3% 1.1% 1.1%

(Three years)

.......................................................................................................................

29.5% Median time to transplant

among recipients enrolled inKPDPP=185 days

30% ...........

15.9%

12.5%

10%

0%

Days from Listing in KPD System to Transplant(Chain closingtransplants to WLpatients not in

the KPDPP)

Time to Transplant for Recipients The 88 recipients of a kidney transplant through the KPDPP waited a median of 185 days12 in the system before the transplant. Figure 10B illustrates that the waiting times among recipients have varied greatly from patient to patient. Although a few recipients waited nearly three years before their KPDPP transplant, 42% were transplanted after waiting for less than six months.

Thirteen recipients (14.8%) benefited from the KPDPP by receiving a transplant without having been entered into the program. These transplants, which are shown in blue in Figure 10B, happened as a result of chains that began with a nondirected donor (NDD) and ended with a patient on the deceased donor waitlist at the transplant hospital that entered the NDD.

Figure 10B: Time Waiting in the KPDPP System for Transplant Recipients — through March 31, 2014

12 This “median waiting time” estimate must be interpreted carefully since it only includes those KPDPP candidates that actuallyreceived a transplant through the program. Figure 10B is intended to be interpreted together with the results shown in Figure 10A.


Figure 12: Time from Match Run to Transplant — through March 31, 2014

250

200

150

91

222

Max

Median 71

134

78

65

Day

s

100

50

0

2010–2012 (n=27) 2013 (n=52) 2014 (n=9)

Year of Transplant

Time between Match Run and Transplant Surgery For the 88 recipients transplanted through the KPDPP, the median time between finding the match and performing the transplant was 71 days. This time lag was primarily due to logistics, such as sending samples for testing, performing crossmatches, financial complexities and scheduling OR dates, but it was also affected by acute changes in a candidate’s or a donor’s health. The lag time has decreased from 91 days in the first few years of the KPDPP to just 65 days in 2014 (Figure 12). The maximum number of days between finding a match and proceeding to transplant has also sharply declined.

The KPD Work Group continues to pursue ways to further reduce the time lag from match offer to transplant. The KPDPP operational guidelines were recently updated to include required timelines for responding to match offers, providing matched donor information, sending test kits and running crossmatches.


gure 13: S dney Graft Surv Comparudes Kidney Transplants Performed October 2010– February 2014

95.1%Deceased donor transplants (n=34,709)

90%

85%

3 months 6 months80% 0 90 180

Gra

ft Su

rviva

l Rat

e

OPTN KPDPP transplants (n=83)

Other living donor transplants (n=19,028)

100%

98.1% (p=0.58)98.8%

95%

Of the 83

KPDP

P transp

lan

t

s wit

h avail

able

da

ta, only tw

o recip

ients (2.4%) have experienced delay function (DGF), defined as requiring dialysis within a week of the transplant. By comparison, 3.1%13

e

d gof raftother living

do

nor

trans

plan

t rec

ipients

and ne

arly

25% of

de

cea

sed donor

recipients experienced DGF during thi s same time period (October 2010 through February 2014).

So far, onl

y one graft

failu

re within

six

mon

ths of t

he transplan e

t s b

ha e

n rep orted.

F

igure 1 w

3 s

ho

s that the estim

at

ed six

month graft survival rate for KPDPP transplants is 98.8%, compared to 98.1% donor kidney transplants and 95.1% for deceased donor kidney transplants. The graft surviv transplants is statist

ic

ally

no diffe

rent from o

ther

liv

ing dono

r trans

plants

(p

=0

.58 , despite

)

for all oal curve a media

ther living

for KPDPPn cold isch

em

ic

Kidney Function after Transplant

time of eight hours in the KPDPP (primarily due to shipping donor kidneys to the recipient center) compared to14just one hour for all other living donor transplants.

Fi ixMonth Ki ival Rate15 ison Incl

Days since Transplant

13 Difference in DGF rates for KPDPP vs. other living donor transplants is not statistically significant (pvalue=0.69, per likelihood ratio chisquared test).

14 Pvalue for difference in graft survival curves is based on the logrank test. 15 KaplanMeier graft survival curves estimated using kidney transplants with a validated Transplant Recipient Registration (TRR)form. Thus, some transplant recipients in this cohort had less than six months of followup, yet this graft survival time can still contribute to the KaplanMeier survival estimates. Patient death, as well as graft failure without patient death, were both considered to be a graft failure. Multiorgan transplants were excluded from deceased donor transplant analysis.


http:p�value=0.69http:transplants.14

2013KPD policy is implemented

2012Match runs revised from

monthly to weekly schedule

2010First KPD match run

& transplants (October)

2007NOTA amended

2012Board of Directorsapproves KPD policy

2011First phase of automated KPD system released

2008OPTN/UNOS Board of Directors approves pilot program

2006 KPD pilot proposal released

KPD Resources For professionalshttp://transplantpro.org/kidneypaireddonation/

For patientshttp://www.transplantliving.org/livingdonation/types/paireddonation/http://unos.org/donation/index.php?topic=kpd

http://optn.transplant.hrsa.gov/resources/KPDPP.asp

Questions?Contact KPD Program Manager Ruthanne Leishman at [email protected] or (804) 7824770, or email [email protected].

OPTN/UNOS KPD Pilot Program Progress Timeline

The State of the OPTN/UNOS KPD Pilot Program

for public comment

18

mailto:[email protected]:[email protected]://optn.transplant.hrsa.gov/resources/KPDPP.asphttp://www.transplantliving.org/living�donation/types/paired�donation/http://unos.org/donation/index.php?topic=kpdhttp://transplantpro.org/kidney�paired�donation

Mark Aeder, M.D. (Chair) Nancy Reinsmoen, Ph.D., D(ABHI) John Friedewald, M.D. Pat McDonough, RN, CPTC, CCTC

OPTN/UNOS KPD Work Group 2013/2014

Richard Formica Jr., M.D. Michael Rees, M.D., Ph.D. Adam Bingaman, M.D., Ph.D. Mike Gallichio, M.D. Mary Amanda Dew, Ph.D. Eric Gibney, M.D. Matthew Cooper, M.D. Alvin Roth, Ph.D. Lloyd Ratner, M.D. Daniel Ranch, M.D. Mariza Turner, RN

Technical Advisors Mary Leffell, Ph.D. Gene Ridolfi, RN, M.H.A. Sommer Gentry, Ph.D.

Tuomas Sandholm, Ph.D. Itai Ashlagi, Ph.D.


KPD_ReportMessage from the KPD Work GroupParticipating Transplant ProgramsCandidates and DonorsMatch Run ParticipatioonTrendsDonor CharacteristicsMatching OpportunitiesTime to TransplantKidney Function after TransplantResources and Program TimelineKPD Work Group Members

a message from kidney paired donation (kpd) work group · 2016. 5. 16. · centersto enter ndds...

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