Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan–Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p < .001), less often female (52% vs. 68%, p < .01), higher BMI (27 vs. 25 kg/m², p = .03), less frequently blood type O (36% vs. 80%, p < .001), and had higher eGFR (99 vs. 94 ml/min/1.73 m², p = .02), with a better LKDPI (median 7 vs. 22, p < .001). We observed no differences in graft failure or mortality. Compatible pairs made 280 additional transplants possible, many in highly sensitized recipients with long wait times. Compatible pair recipients derived several benefits from paired exchange, including better donor quality. Living donor pairs should receive counseling regarding all options available, including kidney paired donation. As more compatible pairs choose to enter exchange programs, consideration should be given to optimizing compatible pair and hard-to-transplant recipient outcomes.

中文翻译：

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配对交换中相容的活体供体-受体对的动机和结果

越来越多的兼容配对选择进入配对交换项目，但参与的动机、结果和系统级影响没有得到很好的描述。通过移植接受者科学登记和国家肾脏登记的联系，我们使用 Kaplan–Meier 方法比较了传统（最初不相容）接受者与最初相容接受者的结果。我们确定了 154 个兼容对。大多数对试图改善 HLA 匹配。与最初的捐赠者相比，实际捐赠者更年轻（39 岁对比 50 岁，p  < .001），女性较少（52% 对比 68%，p  < .01），更高的 BMI（27 对比 25 kg/m² , p  = .03)，O 型血的频率较低（36% 对 80%，p < .001)，并且具有更高的 eGFR（99 对比 94 ml/min/1.73 m²，p  = .02），LKDPI 更好（中位数 7 对比 22，p  < .001）。我们观察到移植物失败或死亡率没有差异。相容对使 280 例额外的移植成为可能，其中许多是高度敏感的接受者，等待时间很长。相容的配对接受者从配对交换中获得了几个好处，包括更好的捐赠者质量。活体捐赠者对应接受有关所有可用选择的咨询，包括肾脏配对捐赠。随着更多兼容对选择进入交换计划，应考虑优化兼容对和难以移植的接受者结果。