Characteristics and Outcomes of Kidneys Accepted versus Turned Down by Regional Centers

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

Am J Transplant

Abstract

Background: The number of kidney transplants performed in the US remains insufficient for the number of patients awaiting one. To meet these demands, it is important to review kidney utilization patterns, particularly for transplanted kidneys turned down by other centers. We performed an analysis of accepted versus turned down kidneys by transplant hospitals in Region 10 to examine kidney acceptance practices and recipient outcomes across the region. Methods: Retrospective analysis of OPTN data for deceased donor kidneys offered by Gift of Life Michigan to Region 10 adult kidney transplant centers between 8/2/22 and 7/19/24. Only kidneys that were ultimately transplanted were included. Offers received by each center were classified as “kidney transplanted by center (KTC)” for those accepted and transplanted by that center and “kidney transplanted elsewhere (KTE)” for those turned down by that center and transplanted elsewhere. Only kidneys turned down for donor variables or organ quality were included in the analysis. Donor characteristics and recipient outcomes were compared between the groups for each center. Outcomes of interest were occurrence of delayed graft function (DGF), recipient 6-month and 1-year serum creatinine (Se Cr), and 6-month and 1-year graft survival (GS). Results: 1046 kidneys, offered to 12 regional centers, were included. One regional center was excluded from the analysis due to lack of recipient 1-year Se Cr data. Center-specific acceptance and turndown rates varied widely and are shown in Figure 1. Selected analysis results are shown in Figure 2. Across multiple centers, KTE kidneys differed significantly in terms of KDPI, donor age, terminal creatinine, biopsy rate, and cold ischemia time. For most centers, recipient outcomes did not differ significantly in terms of DGF, 6-month or 1-year creatinine or GS. Conclusions: Despite differences in organ characteristics, renal outcomes did not differ significantly between KTC and KTE kidneys across the region. While further analysis is needed to elucidate the differences between centers, findings of comparable outcomes with KTE kidneys can help reframe a center’s understanding of acceptable organ quality metrics and motivate centers to rethink and expand their acceptance criteria. DISCLOSURES: Z.Y. Lu: None. A. Yoshida: None. A. Patel: None.

Volume

25

Issue

1

First Page

S34

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