ering flexibility in program implementation. Background KEPs (kidney exchange programs) facilitate living donor kidney transplantations (LDKTs) for patients with incompatible donors, who are typically at higher risk than non-KEP patients because of higher sensitization and longer dialysis vintage. We conducted a comparative analysis of graft outcomes and risk factors for both KEP and non-KEP living donor kidney transplants. Methods All LDKTs performed in The Netherlands between 2004 and 2021 were included. The primary outcome measures were 1-, 5-, and 10-year death-censored graft survival. The secondary outcome measures were delayed graft function, graft function, rejection rates, and patient survival. We used a propensity score–matching model to account for differences at baseline. Results Of 7536 LDKTs, 694 (9%) were transplanted through the KEP. Ten-year graft survival was similar for KEP (0.916; 95% confidence interval, 0.894 to 0.939) and non-KEP (0.919; 0.912 to 0.926, P = 0.82). We found significant differences in 5-year rejection (12% versus 7%) and 5-year patient survival (KEP: 84%, non-KEP: 90%), which was nonsignificant after propensity score matching. Significant risk factors of lower graft survival included high donor age, retransplantations, extended dialysis vintage, higher panel reactive antibodies, and nephrotic syndrome as the cause of ESKD. Conclusions Transplantation through KEP offers a viable alternative for patients lacking compatible donors, avoiding specific and invasive pre- and post-transplant treatments. KEP's similar survival rate to non-KEPs suggests prioritizing KEP LDKTs over deceased donor kidney transplantation, desensitization, and dialysis. However, clinicians should consider the identified risk factors when planning and managing pre- and post-transplant care to enhance patient outcomes. Thus, we advocate for the broad adoption of KEP and establishment in regions lacking such programs, alongside initiation and expansion of international collaborations....

中文翻译：

---

国家肾脏交换计划中良好的活体供体肾移植结果：倾向评分 - 匹配分析


在项目实施方面具有灵活性。背景 KEP（肾脏交换计划）为供体不相容的患者提供活体供体肾移植 （LDKT），由于致敏性更高且透析时间更长，这些患者通常比非 KEP 患者面临更高的风险。我们对 KEP 和非 KEP 活体供体肾移植的移植物结局和风险因素进行了比较分析。方法 纳入 2004 年至 2021 年间在荷兰进行的所有 LDKT。主要结局指标是 1 年、 5 年和 10 年死亡删失移植物存活率。次要结局指标为移植物功能延迟、移植物功能、排斥反应率和患者生存率。我们使用倾向得分匹配模型来解释基线时的差异。结果 在 7536 例 LDKTs 中，694 例 （9%） 通过 KEP 移植。KEP （0.916;95% 置信区间，0.894 至 0.939） 和非 KEP （0.919;0.912 至 0.926，P = 0.82） 的移植物生存率相似。我们发现 5 年排斥反应 （12% 对 7%） 和 5 年患者生存率 （KEP： 84%，非 KEP： 90%） 存在显著差异，在倾向评分匹配后无统计学意义。移植物存活率较低的重要危险因素包括供体年龄高、再移植、透析年龄延长、面板反应性抗体较高以及肾病综合征是 ESKD 的原因。结论 通过 KEP 进行移植为缺乏相容供体的患者提供了一种可行的替代方案，避免了移植前后的特异性和侵入性治疗。KEP 的存活率与非 KEP 相似，这表明 KEP LDKT 优先于已故供体肾移植、脱敏和透析。 然而，临床医生在规划和管理移植前和移植后护理时应考虑已确定的风险因素，以提高患者的预后。因此，我们倡导广泛采用 KEP 并在缺乏此类计划的地区建立，同时启动和扩大国际合作。