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Hard-To-Place Kidney Offers: Granular Examination of Donor Risk Factors for Discard

R. Narvaez, J. Nie, K. Noyes, M. Leeman, L. Kayler.

Dept of Surgery, University at Buffalo, Buffalo, NY
Dept of Epidemiology and Environmental Sciences, University at Buffalo, Buffalo, NY
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.

Meeting: 2018 American Transplant Congress

Abstract number: C61

Keywords: Donors, Kidney, marginal

Session Information

Session Name: Poster Session C: Kidney Donor Selection / Management Issues

Session Type: Poster Session

Date: Monday, June 4, 2018

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background: Deceased-donor kidney discard rates remain high. Understanding risk factors for discard is difficult since most analyses lack granularity and sufficient sample of high disease severity cases. Methods: We analyzed DonorNet® data of consecutive deceased-donor non-mandatory share primary kidney-only offers to adult candidates at our center and beyond between July 1, 2015 and March 31, 2016 for donor risk factors of discard, defined as non-transplantation at our or subsequent transplant centers. Exclusions were HCV/HBV (n=14), blood type AB (n=20), and donor< 1 year (n=25) based on low candidate waitlist size. Results: Of 456 individual kidney offers, from 296 donors, 73% were discarded. Most were national (93%) offers from KDPI 35-85% (n=233) or > 85% (n=208) donors late in the allocation sequence with prior refusals logged for numerous candidates (figure 1). On multivariate logistic regression, factors significantly (p<0.05) associated with discard were: donor CVA (aOR:3.32), cancer transmission concern (aOR:6.50), renal artery luminal compromise (aOR:3.97), 2-hour pump Resistive Index > 0.4 (aOR:3.27), absence of pump (aOR:2.58), biopsy score ≥3 (aOR 5.09)(table 1). Conclusion: Many pre-recovery determinants of discard lack discriminatory value when post-recovery factors are assessed. Our findings underscore the importance of improving precision around donor characteristics that constitute an unwanted offer and provide a more codified understanding of how kidneys previously rejected by local and regional centers are selected for transplant.

CITATION INFORMATION: Narvaez R., Nie J., Noyes K., Leeman M., Kayler L. Hard-To-Place Kidney Offers: Granular Examination of Donor Risk Factors for Discard Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Narvaez R, Nie J, Noyes K, Leeman M, Kayler L. Hard-To-Place Kidney Offers: Granular Examination of Donor Risk Factors for Discard [abstract]. https://atcmeetingabstracts.com/abstract/hard-to-place-kidney-offers-granular-examination-of-donor-risk-factors-for-discard/. Accessed May 9, 2025.

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