Abstract: FR-PO0966
Comparison of Outcomes for Paired Kidney Exchange, End Chain, and Directed Donor Living-Donor Kidney Transplants
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bankulla, Misha R, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Kancherla, Pranav S., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Shah, Divyash V., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Chandrashekar, Sneha, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Tandukar, Srijan, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
Living donor kidney transplants (LDKT) comprise roughly a quarter of all kidney transplants in the US. Directed donor LDKT (D-LDKT) remains the most common, but rising rates of Paired Kidney Exchange LDKT (PKE-LDKT) and End Chain LDKT (EC-LDKT) have expanded access for many waitlisted patients. This study compares graft and patient survival across these LDKT sources.
Methods
We evaluated adult LDKT recipients at the University of Pennsylvania between 1/1/2015 and 11/30/2023. Clinical data on recipient, donor, and transplant characteristics were collected from electronic medical records. Any graft or patient loss was analyzed using Kaplan Meier survival analysis.
Results
Donor age, cold ischemia time, zero HLA mismatch (all p<0.001), and recipient pre-emptive transplant (p=0.002) differ significantly across LDKT groups. On Kaplan Meier analysis, there is no difference in patient survival (p=0.12; Fig 1) or kidney graft survival (p=0.81; Fig 2).
Conclusion
Our study shows similar graft and patient outcomes across D-LDKT, PKE-LDKT and EC-LDKT pathways. Increased participation of transplant programs in PKE and EC-LDKT can improve access to LDKT for more waitlisted patients.
Baseline Characteristics of the Cohort
| Directed Donor LDKT (N = 413) | NKR End Chain (N = 49) | NKR KPD (N = 124) | P-value | |
| Recipient age (years) | 49 (14) | 49 (12) | 49 (14) | 0.79 |
| Recipient female gender | 143 (34.6%) | 25 (51.0%) | 53 (42.7%) | 0.05 |
| Recipient pre-emptive transplant | 248 (60.0%) | 18 (36.7%) | 60 (48.4%) | 0.002 |
| Donor age (years) | 46 (12) | 55 (12) | 42 (12) | < 0.001 |
| Donor female gender | 279 (67.6%) | 33 (67.3%) | 75 (60.5%) | 0.78 |
| Cold ischemia time | 1.6 (1.6) | 4.7 (3.4) | 9.8 (4.6) | < 0.001 |
| Zero HLA mismatch | 19 (4.6%) | 0 (0.0%) | 2 (1.6%) | <0.001 |
Fig 2
Fig 1