Looking Beyond Directed-Donor Transplants: Do End-Chain and Kidney Paired Donation Lead to Similar Graft Outcomes Among Living-Donor Kidney Transplants?

Background: Living donor kidney transplants (LDKT) accounted for roughly 22.3% of all kidney transplants in the US in 2023. In this study, we analyzed the differences in donor and recipient characteristics, and the outcomes among directed donor (D), end chain (EC) and kidney paired donation (KPD) LDKT. Methods: We collected data on LDKT recipients at the University of Pennsylvania between 1/1/2015 to 11/30/2023. Baseline characteristics of patients were compared using ANOVA for continuous variables and chi-squared test for categorical variables. We compared the rates of delayed graft function (DGF) using chi-squared test and estimated glomerular filtration rates (eGFR) at 6 months and 1 year post-transplant among the 3 groups using Kruskal-Wallis test. Results: Donor and recipient characteristics are presented in Table 1. The DGF rates, eGFR at 6 months and 1 year were not statistically different between the 3 groups (p=0.91, 0.06, 0.12 respectively) (Fig 1). Conclusion: Our study shows that EC-LDKT and KPD-LDKT have similar kidney function and DGF rates to D-LDKT. This highlights the importance of expanding these LDKT options to more patients on the waitlist to improve access to transplantation.