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. 2018 Feb;18(2):391-401.
doi: 10.1111/ajt.14449. Epub 2017 Sep 2.

Kidney allograft offers: Predictors of turndown and the impact of late organ acceptance on allograft survival

J B Cohen  1   2 , J Shults  2 , D S Goldberg  2   3 , P L Abt  4 , D L Sawinski  1 , P P Reese  1   2
Affiliations

Kidney allograft offers: Predictors of turndown and the impact of late organ acceptance on allograft survival

J B Cohen et al. Am J Transplant. 2018 Feb.

Abstract

There is growing interest in understanding patterns of organ acceptance and reducing discard. Little is known about how donor factors, timing of procurement, and geographic location affect organ offer decisions. We performed a retrospective cohort study of 47 563 deceased donor kidney match-runs from 2007 to 2013. Several characteristics unrelated to allograft quality were independently associated with later acceptance in the match-run: Public Health Service increased-risk donor status (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 2.29-2.69), holiday or weekend procurement (aOR 1.11, 95% CI 1.07-1.16), shorter donor stature (aOR 1.53 for <150 cm vs reference >180 cm, 95% CI 1.28-1.94), and procurement in an area with higher intensity of market competition (aOR 1.71, 95% CI 1.62-1.78) and with the longest waiting times (aOR 1.41, 95% CI 1.34-1.49). Later acceptance in the match-run was associated with delayed graft function but not all-cause allograft failure (adjusted hazard ratio 1.01, 95% CI 0.96-1.07). Study limitations include a lack of match-run data for discarded organs and the possibility of sequence inaccuracies for some nonlocal matches. Interventions are needed to reduce turndowns of viable organs, especially when decisions are driven by infectious risk, weekend or holiday procurement, geography, or other donor characteristics unrelated to allograft quality.

Keywords: clinical research/practice; donors and donation: deceased; ethics and public policy; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ acceptance; organ allocation; organ procurement and allocation; waitlist management.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Kaplan-Meier curve evaluating all-cause allograft survival by acceptance position tertile
Figure 2
Figure 2
Kaplan-Meier curve evaluating patient survival by acceptance position tertile
See this image and copyright information in PMC

Comment in

References

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