Dr. Kent from Mt. Sinai, NY, presented interesting data about outcomes of kidney sharing in the NY organ donor network. Patients listed for kidney transplantation in NY have among the highest wait times in the USA. Clearly there are not enough local organs for the numerous patients waiting for transplantation in NY. Because of this inequality between supply and demand, NY transplant centers use a large number of expanded criteria kidneys and import a large percentage of kidneys from around the country that would otherwise be discarded. But the question is—are NY transplant recipients being helped by receiving kidneys that other centers are declining?
In short the answer to this question is yes. The authors looked at organ transplants in the NYRT region from 2005 – 2013. More than half of the transplants occurred through the use of imported organs. The imports were more likely to be expanded criteria donors and had longer cold ischemic time (30 hrs vs 16 hrs). Imports were also more likely to be 0 antigen mismatch. Remarkably, graft and patient survival at 1 and 3 years were equal in both groups. GFR was approximately 2 mL lower in the import group at 3 years but this was not statistically significant. In a Cox-proportional hazard model adjusted for covariates kidney share type (local vs. import) did not impact graft loss.
This study has important implications in a country with a growing number of wait-list registrants and a shortage of organs. Allocation polices should support broader organ sharing as clearly certain transplant centers can obtain good results with kidneys that would otherwise be discarded.
Post written by Dr. Vinay Nair, eAJKD Advisory Board member.