Hardest-to-place kidney transplant outcomes in the United States.

Tytuł:: Hardest-to-place kidney transplant outcomes in the United States.
Autorzy:: Kayler LK; Department of Surgery, University at Buffalo, Buffalo, New York, USA.; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.; Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA.
Nie J; Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA.
Noyes K; Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA.
Źródło:: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2021 Nov; Vol. 21 (11), pp. 3663-3672. Date of Electronic Publication: 2021 Jul 20.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2023- : [New York] : Elsevier
Original Publication: Copenhagen : Munksgaard International Publishers, 2001-
MeSH Terms:: Kidney Transplantation*
Tissue and Organ Procurement*
Adult ; Cohort Studies ; Graft Survival ; Humans ; Kidney ; Risk Factors ; Tissue Donors ; United States
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Contributed Indexing:: Keywords: donors and donation: deceased; graft survival; health services and outcomes research; kidney transplantation/nephrology; organ acceptance; organ allocation; organ procurement and allocation; registry/registry analysis
Entry Date(s):: Date Created: 20210702 Date Completed: 20211111 Latest Revision: 20230124
Update Code:: 20240105
DOI:: 10.1111/ajt.16739
PMID:: 34212471
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The outcomes of hardest-to-place kidney transplants-accepted last in the entire match run after being refused by previous centers-are unclear, potentially translating to risk aversion and unnecessary organ discard. We aimed to determine the outcomes of hardest-to-place kidney transplants and whether the organ acceptance position on the match run sufficiently captures the risk. This is a cohort study of the United Network for Organ Sharing data of all adult kidney-only transplant recipients from deceased donors between 2007 and 2018. Multiple regression models assessed delayed graft function, graft survival, and patient survival stratified by share type: local versus shared kidney acceptance position scaled by tertile. Among 127 028 kidney transplant recipients, 92 855 received local kidneys. The remaining received shared kidneys at sequence number 1-4 (n = 12 322), 5-164 (n = 10 485) and >164 (n = 11 366). Hardest-to-place kidneys, defined as the latest acceptance group in the match-run, were associated with delayed graft function (adjusted odds ratio 1.83, 95% confidence interval [CI] 1.74-1.92) and all-cause allograft failure (adjusted hazard ratio [aHR] 1.11, 95% CI 1.04-1.17). Results of this IRB-approved study were robust to the exclusion of operational allocation bypass and mandatory shares. The hardest-to-place kidneys accepted later in the match run were associated with higher graft failure and delayed graft function.
(© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Comment in: Am J Transplant. 2021 Nov;21(11):3516-3518. (PMID: 34327810)
Comment in: Am J Transplant. 2022 Sep;22(9):2281-2282. (PMID: 35338695)

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