Landscape of Living Multiorgan Donation in the United States: A Registry-Based Cohort Study. Issue 7 (July 2018)

• Record Type: Journal Article
• Authors: Henderson, Macey L.; DiBrito, Sandra R.; Thomas, Alvin G.; Holscher, Courtenay M.; Shaffer, Ashton A.; Bowring, Mary Grace; Purnell, Tanjala S.; Massie, Allan B.; Garonzik-Wang, Jacqueline M.; Waldram, Madeleine M.; Lentine, Krista L.; Segev, Dorry L.
• Is Part Of: Transplantation. Volume 102:Issue 7(2018)
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000002082
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. Methods: Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. Results: The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft ( P = 0.2) and patient survival ( P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival ( P = 0.9) and patient survival ( P = 0.7) when compared with recipients from first-time living donors. Conclusions: Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community. Abstract : The authors used SRTR data to characterize living donors who donated more than 1 organ either simultaneously or sequentially. One hundred one cases were identified over the past 2 decades, mostly performed in a small number of centers. One donor died 2.5 years after the second donation but the cause was not recorded and overall, complete follow-up was available for none of the patients. These data are not sufficient to draw conclusions about the value of these procedures. Supplemental digital content is available in the text.