Kidney Allograft Offers: Predictors of Turndown and the Relationship of Organ Acceptance Sequence to Kidney Allograft Survival.
1Renal Division, University of Pennsylvania, Philadelphia, PA
2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
3Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA
4Transplant Surgery, University of Pennsylvania, Philadelphia, PA
Meeting: 2017 American Transplant Congress
Abstract number: A91
Keywords: Allocation, Graft survival, Waiting lists
Session Information
Session Name: Poster Session A: Deceased Donor Issues I: Allocation, KDPI and Recipient Selection
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: There is growing interest in understanding patterns of organ acceptance and reducing organ discard. Little is known about how donor factors, holidays, and location of procurement affect kidney turndown, and whether sequence of kidney acceptance affects allograft outcomes.
Methods: We performed a retrospective cohort study of 64,143 deceased donor kidneys in the Organ Procurement Transplantation Network database procured from 2007-2013, excluding bypassed organs.
Results: Using multivariable ordinal logistic regression clustered by donor, later organ acceptance and organ discard were significantly associated with higher kidney donor profile index ([KDPI]; OR 3.69, 95% CI 3.40-4.02 for acceptance sequence; OR 39.44, 95% CI 34.96-44.49 for discard), Public Health Service (PHS) high risk donor status (OR 2.52, 95% CI 2.32-2.73 for acceptance sequence; OR 2.00, 95% CI 1.80-2.21 for discard), weekend or holiday procurement (OR 1.11, 95% CI 1.06-1.16 for acceptance sequence; OR 1.14, 95% CI 1.08-1.21 for discard), and greater intensity of competition within the donor organ procurement organization ([OPO]; Herfindhal-Hirschman Index OR 1.57, 95% CI 1.49-1.66 for acceptance sequence; OR 1.29, 95% CI 1.20-1.38 for discard). Later organ acceptance was associated with larger OPO waitlist volume relative to organ availability (OR 1.44, 95% CI 1.35-1.53); organ discard was inversely associated with OPO waitlist volume (OR 0.70, 95% CI 0.65-0.76). Using multivariable Cox proportional hazards modeling with adjustment for key donor and recipient factors and clustered by donor, organ acceptance sequence had no significant influence on kidney allograft survival (HR 1.05, 95% CI 0.99-1.11).
Conclusion: Although donor factors, regional factors, and timing contribute to kidney turndown, the sequence of organ acceptance has no impact on allograft outcomes above and beyond other donor and recipient risk factors. Interventions are needed to reduce turndowns driven by factors such as PHS high risk status and holiday procurement. Further, centers may want to ignore the previous number of turndowns when making assessments of graft quality.
CITATION INFORMATION: Cohen J, Shults J, Goldberg D, Sawinski D, Abt P, Reese P. Kidney Allograft Offers: Predictors of Turndown and the Relationship of Organ Acceptance Sequence to Kidney Allograft Survival. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Cohen J, Shults J, Goldberg D, Sawinski D, Abt P, Reese P. Kidney Allograft Offers: Predictors of Turndown and the Relationship of Organ Acceptance Sequence to Kidney Allograft Survival. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-allograft-offers-predictors-of-turndown-and-the-relationship-of-organ-acceptance-sequence-to-kidney-allograft-survival/. Accessed May 11, 2025.« Back to 2017 American Transplant Congress