Low-Quality Kidney Allograft Use in Kidney Transplantation is Associated with a Prolonged Post-Transplant Length of Stay

J. A. Kahla¹, C. R. Goff¹, J. A. Goss², A. A. Rana²

¹Department of Student Affairs, Baylor College of Medicine, Houston, TX, ²Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX

Meeting: 2022 American Transplant Congress

Abstract number: 718

Keywords: Allocation, Length of stay, Outcome, Resource utilization

Topic: Clinical Science » Kidney » 31 - Kidney Deceased Donor Allocation

Session Information

Session Name: Kidney Deceased Donor Allocation

Session Type: Poster Abstract

Date: Saturday, June 4, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 5:30pm-7:00pm

Location: Hynes Halls C & D

*Purpose: The purpose of this study is to determine the effect of low-quality kidney allografts on recipient hospital length of stay following transplant using five different low-quality criteria.

*Methods: In this retrospective multi-center cohort study, 89,458 patients who received transplants from January 1, 2014, through December 31, 2020, were analyzed through hospital discharge. Five criteria were used to classify donor allografts as low-quality: 80^th percentile or greater Kidney Donor Risk Index, expanded criteria donors, death by cardiac death, national share, and age 70 or greater. Length of stay was defined as time from transplant to hospital discharge. Kaplan-Meier survival curves and multivariate Cox regression were used to analyze length of stay.

*Results: 51% (n=45,343) of the 89,458 patients who received a kidney allograft from 2014 through 2020 received a low-quality allograft. Recipients of low-quality allografts were significantly older with an average age of 55.6 compared to 50.4 for recipients of standard allografts (p<0.001). Additionally, recipients of low-quality allografts had significantly higher rates of hypertension (40.3% compared to 31.6%; p<0.001) and diabetes (38.4% compared to 17.6%; p<0.001). There was not a significant difference in glomerular filtration rate at transplant between recipients of low-quality and standard allografts, with both having a median glomerular filtration rate of 13. Kidneys from 80^th percentile Kidney Donor Risk Index donors (95% CI: 0.94 – 0.99), extended criteria donors (95% CI: 0.92 – 0.97), death by cardiac death donors (95% CI: 0.83 – 0.86), and national share donors (95% CI: 0.91 – 0.94) were all associated with significantly prolonged recipient hospital length of stay (hazard ratio <1 signifies later discharge). However, there was no significant difference in length of stay in recipients of kidneys from donors over age 70 years (95% CI: 0.97 - 1.16).

*Conclusions: The use of low-quality kidney allografts is associated with prolonged recipient hospital length of stay except for allografts from donors over age 70 years. Strategies to decrease length of stay in this population should be explored.

To cite this abstract in AMA style:

Kahla JA, Goff CR, Goss JA, Rana AA. Low-Quality Kidney Allograft Use in Kidney Transplantation is Associated with a Prolonged Post-Transplant Length of Stay [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/low-quality-kidney-allograft-use-in-kidney-transplantation-is-associated-with-a-prolonged-post-transplant-length-of-stay/. Accessed May 6, 2025.

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