Clinical Outcomes of Multicenter Domino Kidney Paired Donation

Domino kidney paired donation (KPD) is a method by which an altruistic living nondirected donor (LND) is allocated to a pool of incompatible donor–recipient pairs (DRP) and a series of KPDs is initiated. To evaluate the feasibility and clinical outcomes of multicenter domino KPD, we retrospectively analyzed a cohort of DRPs who underwent domino KPD between February 2001 and July 2007 at one of 16 transplant centers. One hundred seventy‐nine kidney transplants were performed, with 70 domino chains initiated by altruistic LND. There were 45 two‐pair chains, 15 three‐pair chains, 7 four‐pair chains, 2 five‐pair chains and 1 six‐pair chain. A majority of donors were spouses (47.5%) or altruistic LNDs (39.1%). DRPs with a blood type O recipient or an AB donor comprised 45.9% of transplanted DRPs. HLA mismatch improved in transplanted donors compared to intended donors in pairs enrolled to improve HLA mismatch (3.4 ± 0.7 vs. 4.8 ± 1.0, p < 0.001). One‐year and 5‐year graft survival rates were 98.3% and 87.7%, respectively, with a median follow‐up of 46 months. One‐year and 5‐year patient survival rates were 97.2% and 90.8%, respectively. In conclusion, multicenter domino KPD could multiply the benefits of donation from LNDs, with patients and graft survival rates comparable to those seen with conventional KPD.