Missed Opportunities in Kidney Transplantation: Time to Rethink Acceptance Practices

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Some deceased donor kidneys (DDKs) refused by one program are then accepted and transplanted elsewhere, suggesting missed opportunities for transplant. We compared characteristics and outcomes of transplanted DDKs accepted vs. initially refused by our program to assess the appropriateness of our acceptance criteria and identify adjustments needed to reduce missed opportunities. Methods: Retrospective analysis of OPTN data on DDKs offered by a regional OPO to a single center from 8/2022 to 8/2024. Only DDKs that were ultimately transplanted were included. DDKs were classified as either “kidney accepted (KA)” if accepted and transplanted by our program, or “kidney refused (KR)” if turned down by our program and transplanted elsewhere. Only DDKs refused for donor and/or organ reasons were included. Donor and organ characteristics and recipient outcomes were compared between the two groups. 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 (KM) survival analysis was performed with censoring date 8/16/24. Multivariate Cox regression of graft loss was performed on all variables. Results: 312 kidneys were included, with 65 (20.8%) in the KA group and 247 (79.2%) in the KR group. 89.5% of KR were turned down for organ-specific reasons, most often for unacceptable organ-specific test results (30%) and organ anatomical damage/defect (24.6%). KR kidneys had a higher degree of glomerulosclerosis and came from donors with higher KDPI and terminal creatinine. Other donor and kidney characteristics did not differ significantly between groups. Outcomes were similar between groups across all measures (Table 1). [Formula presented] On multivariate analysis, DGF was significantly associated with graft loss (HR 5.2, 95% CI [1.33 - 20.43], p=0.02) across the entire cohort. Kidneys that were initially refused (KR group) had a similar risk of failure as KA kidneys (HR 1.5, 95% CI [0.42 - 5.39], p=0.54). No significant risk factors for graft loss were identified within groups. Conclusions: Despite differences in donor and kidney characteristics, we found comparable allograft outcomes between KA and KR groups, indicating a need to rethink our acceptance filters and highlighting the importance of systematic review of donor exclusion criteria in every program. CITATION INFORMATION: Lu Z., Patel A., Yoshida A. Missed Opportunities in Kidney Transplantation: Time to Rethink Acceptance Practices AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: Z. Lu: None.

Volume

25

Issue

8

First Page

S374

Last Page

S375

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