Living Paired Exchange Donation: Unlocking New Horizons in Kidney Transplantation

To compare the clinical outcomes and costs of kidney paired donation (KPD) with other kidney transplant options in patients who are unable to undergo living donor transplant because of blood- or tissue-type incompatibility.

We retrospectively analyzed kidney transplants at our center using data from the United Network for Organ Sharing and Mayo Clinic in Rochester, Minnesota, from January 1, 2017, to January 1, 2023. Patients were categorized by kidney source as follows: deceased donor kidney (DDK), living donor traditional (LDT), KPD-local, and KPD-external. Financial data were collected to assess the cost benefits of KPD compared with traditional options.

We analyzed 1266 adult kidney transplants, including 406 DDK, 611 LDT, 151 KPD-external, and 98 KPD-local transplants. Graft failure rates were higher in the KPD-external group (3.3% [5 of 151]) than in the DDK (2.7% [11 of 406]), KPD-local (1.0% [1 of 98]), and LDT (2.5% [15 of 611]) groups, although these differences were not statistically significant. The medical costs were assessed at 30, 90, and 365 days. At 30 days, costs were DDK, $86,769±$69,989; LDT, $115,597±$28,002; KPD-external, $109,769±$32,704; and KPD-local, $124,660±$88,627 (P=.001 for DDK).

Our findings provide insights into transplant outcomes, suggesting that KPD is similar to traditional kidney transplant.