2010 - TTS International Congress


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Organ Donation and Allocation I

88.3 - Outcomes and Distributional Efficacy of Kidneys rejected by local and regional centers in the United States

Presenter: Liise, Kayler, Gainesville, United States
Authors: Kayler L., Sokolich J., Magliocca J., Schold J.

OUTCOMES AND DISTRIBUTIONAL EFFICACY OF KIDNEYS REJECTED BY LOCAL AND REGIONAL CENTERS IN THE UNITED STATES

ORGAN DONATION AND ALLOCATION I

L.K. Kayler1, J. Sokolich1, J. Magliocca1, J. Schold2
1Surgery, Shands Hospital, University of Florida, Gainesville/UNITED STATES OF AMERICA, 2, Shands Hospital, University of Florida, Gainesville/UNITED STATES OF AMERICA

Body: INTRODUCTION: Kidney distribution in the United States has been shown to lack efficiency in the placement of kidneys with prolonged cold ischemia times (CIT); however, no studies have evaluated kidney transplant (KTX)outcomes and distributional efficacy within the current UNOS construct of kidney allocation first to local, regional, and then national centers. METHODS: Using data from the Scientific Registry of Transplant Recipients from January 2005 to July 2009 of isolated deceased-donor KTXs excluding 0-mismatch, paybacks, and other mandatory shares, recipient outcomes stratified by location of kidney transplanted at local and regional centers (n=32,140) compared to national (n=4,352) centers were ascertained using multivariate regression models , including donor and recipient factors. Changes in CIT time were assessed by transplant location and compared between two eras, prior to and after mandatory employment of DonorNet (April 30, 2007). RESULTS: Non-mandatory share kidneys transplanted nationally demonstrated similar patient death [adjusted hazard ratio (aHR), 0.95; 95% confidence interval (CI), 0.82, 1.11] and graft loss [aHR, 0.99; CI, 0.89, 1.11] relative to kidneys transplanted locoregionally. Removal of donor variables (ie. only recipient variables included) in the model resulted in similar graft and patient outcomes. The likelihood of delayed graft function was higher amongst national transplants (adjusted odds ratio (aOR), 1.43; CI 1.33, 1.54) adjusting for recipient and donor variables excluding CIT; however, inclusion of CIT in the model reduced the likelihood of DGF significantly (aOR, 1.13; CI 1.04, 1.23). Mean CIT did not change pre vs. post-DonorNet for local transplants (15.8 vs 15.8 hours , respectively (p=0.68), but CIT significantly increased for regional transplants (22.5 vs 23.5 hours, respectively, p=0.02) and national transplants (26.6 to 27.5, respectively, (p=0.001) between the two eras. CONCLUSIONS: Outcomes of non-mandatory share kidneys transplanted to the national list are similar to those accepted locoregionally, even when not adjusted for donor factors, suggesting that clinical biases that influence decision making for kidney acceptance are variable and better tools are needed to identify kidneys with poor outcomes. DGF is significantly greater amongst national transplants and is explained to a large degree by long CITs. Significantly increasing CITs over time amongst regional and national, but not local transplants, indicates that DonorNet has not served to improve the distributional efficiency of locally rejected kidneys.

Disclosure: All authors have declared no conflicts of interest.


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