Kidney Transplant Outcomes and Organ Acceptance Practice Patterns: Nationwide Analyses of the US and France
1Paris Translational Center for Organ Transplantation, Paris, France, 2Department of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, 3Agence de la Biomédecine, Paris, France
Meeting: 2019 American Transplant Congress
Abstract number: 219
Keywords: Allocation, Kidney
Session Information
Date: Monday, June 3, 2019
Session Name: Concurrent Session: Kidney Donor Selection / Management Issues II
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Ballroom C
*Purpose: Approximately 3,500 donated kidneys are discarded in the US each year, drawing concern from Medicare and advocacy groups. We hypothesised that more aggressive organ acceptance practices would provide substantial benefit to waitlisted kidney transplant candidates and increase the donor pool.
*Methods: We performed a nationwide study using registries from the US and France comprising comprehensive cohorts of deceased donors with organs offered to kidney transplant centers between 2004 and 2014. We compared practice patterns and used logistic regression as well as computer modelling of organ acceptance and discard practices in both countries. Based on actual survival data, we then quantified the number of years of allograft life that a redesigned US system would have saved.
*Results: During the observation period, 156,089 kidneys in the US were recovered from deceased donors, of which 128,102 were transplanted, and 27,987 (17.9%) were discarded. In France, among the 29,984 kidneys recovered from deceased donors, 27,252 were transplanted, and 2,732 (9.1%) were discarded. The mean age of kidneys transplanted in the US was 36.51±17.02 years versus 50.91±17.34 years for those in France (p<0.0001). Kidney quality showed little change in the US over time (mean kidney donor risk index [KDRI] 1.30±0.48 in 2004 versus 1.32±0.46 in 2014), while a steadily-rising KDRI in France reflected a temporal trend of more aggressive organ use (mean KDRI 1.37±0.47 in 2004 versus 1.74±0.72 in 2014, p<0.0001). We applied the French-based allocation model to the population of US deceased donor kidneys and found that 17,435 (62%) of kidneys discarded in the US would have instead been transplanted under the French system. We further evaluated that a redesigned system with less restrictive organ acceptance practices translated to an additional 132,445 allograft life years that would have been saved in the US over the 10-year observation period.
*Conclusions: Greater acceptance of kidneys from older deceased donors in the US could provide major survival benefits to the population of waitlisted patients.
To cite this abstract in AMA style:
Aubert O, Reese PP, Bouatou Y, Raynaud M, Legendre C, Glotz D, Lefaucheur C, Jacquelinet C, Loupy A. Kidney Transplant Outcomes and Organ Acceptance Practice Patterns: Nationwide Analyses of the US and France [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplant-outcomes-and-organ-acceptance-practice-patterns-nationwide-analyses-of-the-us-and-france/. Accessed March 9, 2021.« Back to 2019 American Transplant Congress