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The feasibility and effectiveness of kidney paired donation (KPD) for the management of patients with incompatible donors were determined. Evidence suggests that recipients with incompatible live donors, even those with rare blood type combinations, can receive transplants through KPD with graft survival rates equivalent to directed, compatible liver donor transplants.

Hypothesis: The use of kidneys from deceased donors considered at increased infectious risk represents a strategy to increase the donor pool. Design: Single-institution longitudinal observational study. Setting: Tertiary care center. Patients: Fifty patients who gave special informed consent to receive Centers for Disease Control and Prevention high-risk (CDCHR) donor kidneys were followed up by serial testing for viral transmission after transplantation. Nucleic acid testing for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus was performed on all high-risk donors before transplantation. Outcomes of CDCHR kidney recipients were compared with outcomes of non-high-risk (non-HR) kidney recipients. Main Outcome Measures: New viral transmission, graft function, and waiting list time. Results: No recipient seroconversion was detected during a median follow-up period of 11.3 months. Compared with non-HR donors,CDCHR donors were younger (mean [SD] age, 35 [11] vs 43 [18] years, P=.01), fewer were expanded criteria donors (2.0% vs 24.8%, P<.001), and fewer had a terminal creatinine level exceeding 2.5 mg/dL (4.0% vs 8.8%, P=.002). The median creatinine levels at 1 year after transplantation were 1.4 (interquartile range, 1.2-1.7)mg/dL for CDCHR recipients and 1.4 (interquartile range, 1.1-1.9) mg/dL for non-HR recipients (P=.4). Willingness to accept a CDCHR kidney significantly shortened the median waiting list time (274 vs 736 days, P<.001). Conclusions: We show safe use of CDCHR donor kidneys and good 1-year graft function. With continued use of these organs and careful follow-up care, we will be better able to gauge donor risk and match it to recipient need to expand the donor pool and optimize patient benefit. [ABSTRACT FROM AUTHOR]