Introduction: Risks associated with deceased donors may be donor-related, organ-related, or both. Variations between transplant centres in the risks they are prepared to accept ('risk profile'), and the impact on patient and graft outcomes have been poorly characterised. This registry analysis aims to address these issues. Methods: Adult recipients of deceased donor kidney transplants (DDKTx) between 2006 and 2015 were identified. Nine donor and operative variables perceived to be associated with increased risk (donor hypertension, diabetes, age >70 years, malignancy, increased risk behaviour for blood-borne viral diseases, meningitis / encephalitis, UKKDRI >1.60, DCD donor, and dual transplantation) were compared between units. Novel risk scores were developed based on centre quartiles and ranking for each variable. Centres were compared over the entire study period, and in early and late 5-year eras. They were divided into four groups based on risk score. Logistic regression analyses were used to examine interactions between centre risk and patient outcomes. Results: Over 10 years, 14,619 DDKTx were carried out from 8,632 deceased donors. The proportion of DDKTx carried out from the donor risk groups varied widely between centres, and some centres markedly increased their 'risk profile' from early to late eras. Patients were significantly more likely to receive a transplant if they were listed at a 'high risk' centre versus a 'low risk' centre (odds ratio 2.1 (95% CI 1.9-2.2), p<0.001). No difference in unadjusted 5-year first kidney graft survival was apparent between 'low risk' centres or 'high risk centres' (85.8% vs. 86.6%, p=0.43). Patient survival from listing appeared to be no worse in 'high risk' than low risk centres. Discussion: UK kidney transplant centres display wide variation in their appetite for risks associated with deceased donors, with centres altering their donor 'risk profile' markedly over the last 10 years. Unadjusted patient and graft outcomes appear no worse in higher risk centres, and waiting times for transplantation were shorter, suggesting that accepting kidneys perceived as higher risk may be a beneficial strategy for the local waiting list population.

CITATION INFORMATION: Trotter P, Robb M, Summers D, Bradley J, Neuberger J, Callaghan C. Variations in Risk-Appetite Between UK Kidney Transplant Centres and Impact on Patient and Graft Outcomes. Am J Transplant. 2017;17 (suppl 3).

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