© 2022 Simon Says Seminars, inc.| TransplantStrong
 
 
Transplanted kidneys don’t last forever—though we silently pray they’ll last for “our” lifetime.
 
On average, a transplant from a living donor lasts about 18-19 years, while a kidney from a deceased donor lasts about 11-13 years.1
 
The term of graft function can vary greatly, depending on the age of the donor, the age of the recipient, and other medical issues. 
 
Preemptive (live kidney donor) transplant recipients (and those with less than 6 months on dialysis prior to transplant), can expect the best long-term success. But how long is “long-term”?
 
 
While there isn’t a crystal ball on these variables, transplant recipients who commit to living a healthy life and take their immunosuppressive medications religiously have a far better chance at reducing their risk of rejection. Adopting proactive strategies to prepare for the “possibility” of needing a 2nd transplant can be an incredibly smart move. It’s equally smart for live-donor recipients to ensure the future of their living donors.
 
In this space, recipients agree to extend their public awareness campaigns to include their possible need for a 2nd transplant, as well as their donor’s possible need for a transplant someday. While some may argue it’s unlikely, the possibility cannot be predicted long before the need. This concept provides awareness and possible engagement to support peace of mind. 
In this model of public awareness, both recipients and their donors need to talk-up this unthinkable (but possible) reality of needing to find another living kidney donor someday.
“Extend & Renew mindsets encourage transplant recipients (and their respective donors) to proactively inspire living donation for others as well as their own future needs.”   
When a transplant recipient experiences graft loss or when their living kidney donor finds themselves dealing with renal insufficiency, they face two options: (1) waiting for a deceased donor or (2) searching for a suitable living kidney donor, both of which can take years. By encouraging new living kidney donors to consider their future needs when donating to a stranger, everyone wins through better outcomes.
 
Given that early workups are advised for recipients with failing grafts, having  interested back-up donors can be most reassuring. Of course, having their name on the National Kidney Registry’s (NKR) Family Voucher Program (from a person who already donated to a stranger) provides the optimal solution for unpredictable needs and timelines. 5
 
Proactive engagement of this nature can also minimize or completely eliminate the need for dialysis prior to transplant. 2
 
In repeat transplants, the risk of mortality can be significantly reduced by spending less time on the waitlist as well. Furthermore, repeat renal transplants from living donors have comparable outcomes to first transplants, making transplants from living donors the best choice for patients with allograft loss.
 
A living donor kidney has the greatest impact on improving graft and recipient survival in patients with multiple kidney transplants. 2
It should be noted that while it might initially seem sensible to withdraw immunosuppression to reduce the risk of cardiovascular, neoplastic and infective complications (in patients fit for a subsequent transplant after graft failure) — this can often result in a high degree of sensitization to HLA, namely the production of donor-specific HLA antibodies (DSA) and other panel-reactive antibodies (PRAs). 2
 

 Voucher Programs Save Lives Now, While Protecting Future Needs. 3

Transplant recipients (and living kidney donors) have a win-win opportunity to educate and encourage healthy people to consider living kidney donation. This is so more people can be helped today, while at the same time they can be protecting their own future.  

 
This is a novel concept that is offered under the National Kidney Registry’s Family Voucher Program. Here’s how it works: An inspired kidney donor who wants to “share their spare” to help a stranger today, while also protecting the future of someone they care deeply about, can do so at their convenience (before their listed loved ones are in need).3
 

Simply put: The Family Voucher Program allows a qualified donor candidate to donate one of their kidneys to a stranger as soon as they are able, to protect the future needs of a friend or loved-one.  

By donating through the Family Voucher Program, donors can donate according to their schedule. Before donating, they can list up to five family members (or friends) who are not in imminent need of a transplant, as a way to protect one of those five listed should they ever need a transplant in the future. Only one of the five listed can use their voucher, and after one voucher has been used, the other four vouchers are void.

The most wonderful thing about the Family Voucher Program is that it presents an opportunity for goodhearted people to save and improve the life of at least one stranger today (and possibly many more if they’re involved in a chain of multiple donors and recipients).

They can also help someone on the deceased donor waitlist. Yet, no matter how their donation is utilized, they can still protect the future needs of one of the five people listed on their voucher agreement. When that voucher is redeemed, the voucher holder will be prioritized for a living donor kidney through the National Kidney Registry (NKR) Family Voucher Program. (Family voucher donors are also eligible for the support and protections covered by Donor Shield) 

 *(It should be noted that NKR also offers “Standard Vouchers” for hopeful recipients in immediate need).

NKR’s “Kidney for Life” Initiative

NKR’s Kidney for Life initiative, utilizes the latest generation in DNA sequencing technology to assess the histologic, or eplet, mismatch between patients and donors, which increases the odds of a better match for the recipient. 4,5

Eplet assessments allow transplant centers to more effectively select donors for specific recipients by better understanding the epitope mismatch risk factor between the donor and recipient. Epitope mismatch risk assessment use matching technology more effectively than traditional antigen matching.

Studies have shown that getting a low-risk match based on epitope mismatch risk assessment creates an opportunity to safely reduce immunosuppression dosages.

Let’s look at the value of eplets  

  • Identify an antigen mismatch (which is where rejection often starts). Antigens are made up of eplets. An eplet mismatch between a donor and recipient allows the recipient’s medical team to better understand the risk of rejection. 4,5
  • Can reduce the risk of de novo DSA formation and lower the probability of rejection and graft failure.5
  • Can lower the recipient’s immune-suppression dosage
  • Ultimately, lead to the recipient only requiring one transplant during their lifetime.5

The only pair that cannot benefit from entering paired exchange to find a low eplet mismatch is a six-antigen sibling pair.4

1. 2023. Actively pursuing research on extending life of  kidney transplant. Massachusetts  General Brigham, Kidney Transplant Center. https://www.youtube.com/shorts/zDbfNOSjZH8
3. Jeffrey L. Veale, MD, et al. (2021) Voucher-Based Kidney Donation and Redemption for Future Transplant. JAMA Surgery | Original Investigation. https://www.kidneyregistry.org/wp-content/uploads/2021/07/Veale_First-250-Vouchers_JAMA_Surg_2021.pdf
4. Aleksandar Senev, et all. 2020. Eplet Mismatch Load and De Novo Occurrence of Donor-Specific Anti-HLA Antibodies, Rejection, and Graft Failure after Kidney Transplantation: An Observational Cohort Study. https://www.kidneyregistry.org/wp-content/uploads/2021/03/EpletMM.pdf
5. 2024. NKR’s Kidney for Life Initiative. https://www.kidneyregistry.org/for-patients/kidney-for-life.

A Word About Voucher Program

Why? Because it can take months to match recipients with incompatible donors (especially blood types B and O recipients), the National Kidney Registry (NKR), and the Alliance for Paired Donation (APKD) offer Voucher Programs as an alternative.

What they do: Vouchers allow a living kidney donor to donate to a stranger (at a convenient time and location), to secure a match for their incompatible recipient in immediate need.

Options: Altruistic donors don’t have to have a recipient in immediate need to enter the voucher program. They can choose to donate to a stranger and use the voucher program to the future of protect loved ones.

Here’s how it works: The donor can list up to five loved ones as “voucher holders,” whether they listed a recipient in immediate need, or not. More specifically, loved ones can be listed (1) as primary voucher holders, or (2) as “back-up” voucher holders, when the donor’s intended recipient didn’t need to use their voucher. In either case, only one listed person is eligible to use their voucher, which is based on the “first in need.”

For a list of transplant centers contracted with NKR’s KPD and Voucher Programs: https://www.kidneytransplantcenters.org/