Kidney paired donation: advancements and future directions

Purpose of review Kidney paired donation (KPD) has become a viable option for patients in need of a kidney transplant who have a willing, but incompatible living donor. The purpose of this review is to highlight the recent advances in KPD including shipping live-donor kidneys to their intended recipient, enrolling compatible pairs, and combining KPD with desensitization. Recent findings KPD has been expanded and facilitated by multiple organizations. KPD chains have been extended from single-center two-way 'swaps' to transcontinental KPD chains in which living-donor organs have been shipped without compromising outcomes. Living-donor kidneys have been shipped transcontinentally on commercial airlines with great success. Enrollment of compatible donor-recipient pairs, particularly those with blood group O donors, is one strategy that has been employed to extend KPD to even more patients. It has also become more apparent that KPD can be successfully combined with desensitization in order to transplant our most immunologically challenging patients. Summary KPD is becoming an established method of transplantation at transplant centers throughout the world. Advancements have been made through shipping living-donor kidneys, combining KPD with desensitization, and enrolling compatible pairs.