Kidney Transplant Chains Boost Benefit

Kidney transplant chains augment the benefit of nondirected donors, according to investigators.

In a study, researchers found that altruistic nondirected donors (NDDs) triggered almost five transplants on average, and more if the NDD was blood type O.

Marc L. Melcher, MD, PhD, of Stanford University in Palo Alto, Calif., and colleagues reviewed a large multicenter living donor-recipient database that contained information about donor-recipient pairs from 57 U.S. transplant centers. Their analysis revealed that 77 NDDs enable 373 transplantations over 46 months beginning in February 2008, according to a report in JAMA Surgery (2013;148:165-169). The mean chain length initiated by the NDs was 4.8 transplants (median 3.0), according to the investigators. The 40 blood type O NDDs triggered a mean chain length of 6.0 (median 4.0). During the interval, 66 of 77 chains were closed to the wait list, and four were ongoing; seven were broken because bridge donors became unavailable. No chains were broken in the last 15 months of the study period and every recipient whose incompatible donor donated received a kidney. A total of 133 blood type 0 recipients were transplanted.

“The benefits of transplanting 373 patients and enabling others without living donors to advance outweigh the risk of broken chains that is decreasing with experience,” the authors concluded.

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