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Hard-To-Place Kidney Offers: System- Level Predictors of Discard

L. Kayler,1 J. Nie,2 K. Noyes,2 M. Leeman,3 R. Narvaez.1

1Dept of Surgery, University at Buffalo, Buffalo, NY
2Dept of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
3Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.

Meeting: 2018 American Transplant Congress

Abstract number: 516

Keywords: Allocation, Donors, Kidney, marginal, Risk factors

Session Information

Session Name: Concurrent Session: Kidney Donor Selection / Management Issues - 2

Session Type: Concurrent Session

Date: Tuesday, June 5, 2018

Session Time: 4:30pm-6:00pm

 Presentation Time: 4:42pm-4:54pm

Location: Room 6E

Background: Deceased-donor kidney discard rates remain high. Inefficiencies in the allocation of hard-to-place kidneys may be contributing to discard suggesting that system-level factors represent opportunities to improve placement. 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 to identify system- level risk factors of discard independent of donor quality. Discard was 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). Each system-level factor was separately entered into the multivariate model containing donor-level factors and those that remained significant independent factors associated with discard were increasing offer cold ischemia time (11-15 hours: aOR 2.07, 95%CI 1.08-3.97; 16-20 hours: aOR 2.33, 95%CI 1.15-4.75; ≥21 hours, aOR 2.82, 95%CI 1.30-6.13), increasing refusal number (501-1000, aOR 2.23, 95%CI 0.77-6.44; 1001-2000, aOR 6.68, 95%CI 2.78-16.07; 2001-3000, aOR 2.39; >3000, aOR 5.34, 95%CI 2.09-13.62), night-time offer (aOR 2.19; 95%CI 1.18-4.10), and neither kidney placed at time of offer (aOR 2.74, 95%CI 1.60-4.72). Absence of kidney picture was borderline significant (aOR 1.61, 95%CI 0.97-2.67) (Table 1). Conclusion: System-level factors regarding allocation efficiencies and information quality influence discard and should be considered to inform future interventions.

CITATION INFORMATION: Kayler L., Nie J., Noyes K., Leeman M., Narvaez R. Hard-To-Place Kidney Offers: System- Level Predictors of Discard Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Kayler L, Nie J, Noyes K, Leeman M, Narvaez R. Hard-To-Place Kidney Offers: System- Level Predictors of Discard [abstract]. https://atcmeetingabstracts.com/abstract/hard-to-place-kidney-offers-system-level-predictors-of-discard/. Accessed June 5, 2025.

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