Toward Better Organ Utilization: Identifying Missed Opportunities in Kidney Transplantation

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Some deceased donor kidneys (DDKs) refused by one transplant program are then accepted and transplanted elsewhere, indicating missed opportunities. We compared characteristics and transplant outcomes of DDKs accepted vs. initially refused by programs within one OPTN region to assess acceptance and utilization patterns across the region. Methods: Retrospective analysis of DDKs offered by a regional OPO to adult kidney programs from 8/2022 to 8/2024. Only DDKs that were transplanted were included. DDKs were classified as “kidney accepted (KA)” if accepted and transplanted by a regional program, or “kidney refused (KR)” if turned down by a regional program for donor and/or organ reasons and transplanted elsewhere. Programs were grouped into 3 tiers based on acceptance rate. Donor and kidney features and recipient outcomes were compared between groups in each tier. Outcomes of interest were rate of delayed graft function (DGF), recipient 6-month and 1-year serum creatinine (Se Cr) and 1-year graft survival (GS). Kaplan Meier survival analysis was performed with censoring date 8/16/24 and a Cox proportional hazards model was used to quantify the effect of initial refusal on graft loss. Results: 1046 DDKs, offered to 12 programs, were included. Program-specific acceptance rates ranged 7.1 - 35.7%, with 3 programs in the top tier (acceptance rate >20%), 5 in the middle (rate 10-20%), and 4 in the bottom (rate <10%). Over 75% of KR were refused for organ quality reasons, most often unacceptable biopsy and/or organ-specific results. Selected results are shown in Table 1. Across all tiers, KR kidneys had older donors with higher KDPI, longer cold ischemia time, and higher biopsy rates. DDKs accepted by the top tier had the fewest number of significant between-group differences (8 of 16 examined features), while those accepted by the middle tier had the most (12 of 16). DGF rates were higher in KR groups in the top and bottom tiers. Other outcomes were similar between groups across all tiers. KR kidneys had a nonsignificant higher risk of graft loss in the middle and bottom tiers. [Formula presented] Conclusions: With few exceptions, program acceptance rates were low (<20%), reflecting a need to improve DDK utilization across the region. Despite differences in baseline characteristics, we found overall comparable allograft outcomes between KA and KR groups, indicating a need for programs to rethink their donor acceptance and exclusion criteria. CITATION INFORMATION: Lu Z., Patel A., Yoshida A. Toward Better Organ Utilization: Identifying Missed Opportunities in Kidney Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: Z. Lu: None.

Volume

25

Issue

8

First Page

S375

Last Page

S376

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