Abstract: SA-PO064
Should Kidneys at High Risk for Discard Be Allocated to Preemptive Deceased Donor Kidney Transplant Candidates?
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Gill, Justin, University of British Columbia, Vancouver, British Columbia, Canada
- Kadatz, Matthew J., University of British Columbia, Vancouver, British Columbia, Canada
- Gill, John S., (St. Paul's Hospital/University of British Columbia), Vancouver, British Columbia, Canada
- Gill, Jagbir, St. Paul's Hospital, West Vancouver, British Columbia, Canada
Background
Over 19% of recovered kidneys are discarded annually in the US. Identifying patients with favourable outcomes after transplantation with kidneys at high risk of discard may inform strategies to increase organ utilization. Preemptive deceased donor kidney transplant recipients have superior post-transplant outcomes compared to recipients on dialysis, partly due to the presence of native kidney function. We hypothesize that allocation of kidneys at high risk of discard to selected preemptive candidates could offer acceptable outcomes.
Methods
We ranked and grouped into quartiles all deceased donors in SRTR between 2000-15 based on their probability of kidney discard using a validated score that predicts discard based on donor characteristics. We conducted a paired kidney analysis, where 1 kidney was transplanted in a preemptive recipient and the mate kidney from the same donor was transplanted into a nonpreemptive recipient, to compare the risk of DGF and all cause graft loss (ACGL) in non-preemptive and preemptive recipients, stratified by donors’ risk of kidney discard using Cox and logistic regression models.
Results
The figure shows unadjusted graft survival in preemptive and non-preemptive recipients, stratified by donors’ probability of kidney discard. The risk of discard was associated with inferior graft survival, as recipients of kidneys at the greatest risk of discard (Q4) demonstrated the worst graft survival. However, outcomes among preemptive recipients were significantly better. After adjusting for recipient and transplant factors, preemptive recipients who received kidneys at the greatest risk of discard (Q4) had a significantly lower risk of DGF (OR; 95%CI 0.22; 0.18-0.26) and of ACGL (HR; 95%CI 0.81; 0.72-0.90).
Conclusion
Allocation of kidneys at high risk of discard to selected preemptive candidates (eg. patients with prolonged wait-times) may increase organ utilization while optimizing outcomes.