Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants

Abstract

SummaryThe disparity between kidney transplant candidates and donors necessitates innovations to increase organ availability. Transporting kidneys allows for living donors and recipients to undergo surgery with a familiar transplant team, city, friends, and family. The effect of shipping kidneys and prolonged cold ischemia time (CIT) with living donor transplantation outcomes is not clearly known. This retrospective matched (age, gender, race, and year of procedure) cohort study compared allograft outcomes for shipped live donor kidney transplants and nonshipped living donor kidney transplants. Fifty-seven shipped live donor kidneys were transplanted from 31 institutions in 26 cities. The mean shipping distance was 1634 miles (range 123-2811) with mean CIT of 12.1 AE 2.8 h. The incidence of delayed graft function in the shipped cohort was 1.8% (1/57) compared to 0% (0/57) in the nonshipped cohort. The 1-year allograft survival was 98% in both cohorts. There were no significant differences between the mean serum creatinine values or the rates of serum creatinine decline in the immediate postoperative period even after adjusted for gender and differences in recipient and donor BMI. Despite prolonged CITs, outcomes for shipped live donor kidney transplants were similar when compared to matched nonshipped living donor kidney transplants.

Shipping living donor kidneys and transplant recipient outcomes

“…Although that study had longer follow-up (median 6.6 years), their maximum CIT was only 8 hours, less than the median CIT of 9 hours and a maximum of 23.9 hours in this study. Other previous studies of living donor exchange programs and shipping kidneys in the U.S. were limited by small sample sizes and shorter CIT, but report similar findings to what this study reports in regards to DGF and graft and patient outcomes (5, 6). …”

“…Details of the NKR have been previously described (5). NKR policies are available online at: http://www.kidneyregistry.org.…”

“…Our ability to evaluate and compare these different policies on shipping kidneys and establish an evidence-based, standard approach is limited by a paucity of research. Initial preliminary studies of shipped LDKT in KPD programs have suggested minimal to no association between CIT and graft or patient outcomes, however these studies were limited by small sample sizes and minimal follow-up times (5, 6). Additionally, none of these studies identified potential risk factors or predictors of poorer outcomes in shipped KPD kidneys with prolonged CIT.…”

Innovative Applications of Robotic Surgery: Renal Allograft and Autologous Transplantation

“…Total operative time was 425 minutes and total ischemic time was 127 minutes. While this pioneering report demonstrated the safety and feasibility of robotic-assisted ReATx, the described technique was associated with longer ischemia than one would encounter with the conventional approach to ReATx: laparoscopic donor nephrectomy, ex vivo preparation, and open auto-transplantation 9, 23 .…”

Challenges of kidney paired donation transplants involving multiple donor and recipient surgeons across Australia

“…Counterarguments to donor travel include the donor unfamiliarity with the recipient transplant team, the greater risk of loss of donor anonymity and disrupted family care and support, risk of decline of matched donors or delays in accepting a donor by the recipient's transplant centre because of the need for additional testing . For these reasons, some KPD programs have embraced the practice of shipping live donor kidneys . Reports describing the incidence of DGF and outcomes after shipping living donor kidneys remain sparse …”