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Maximizing Utilization of Marginal Kidneys in a Small, Geographically Isolated Transplant Program: 10 Year Experience

J. Africa, R. King, L. Lipscomb, A. Patel, A. Jones

Charleston Area Medical Center, Charleston, WV

Meeting: 2020 American Transplant Congress

Abstract number: C-014

Keywords: Allocation, Cadaveric organs, Elderly patients, Kidney transplantation

Session Information

Session Name: Poster Session C: Kidney Deceased Donor Allocation

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: The initial experience with the kidney allocation system (KAS) resulted in an alarming decrease in the number of transplants in our small and isolated center. We hypothesized listing and transplanting older candidates and accepting more marginal kidneys would increase transplants without compromising outcomes.

*Methods: 10-year waitlist additions and deceased donor kidney transplants were retrospectively analyzed 5 years pre-KAS (1/1/10-12/3/14) and 5 years post-KAS (12/4/14-10/31/19). The first 3 years of post-KAS was then compared to year 4-5. X2, Fisher’s exact test, t-test, K-M estimate were used for statistical analysis.

*Results:

5 years pre-KAS 5 years post-KAS P value Yr 1-3 post-KAS Yr 4-5 post-KAS P value
WAITLIST ADDITIONS
Total 302 347 208 139
Mean Age (y) 52 56 55 56
% Age 65+ 16 24 .01 21 27 ns
BMI ave 29 30 31 30
% BMI 30+ 47 55 .04 55 56 ns
TRANSPLANTS
TOTAL 202 236 90 145
Deceased (Ave/yr) 180 (36) 203 (40) 77 (26) 126 (63)
Living 22 32 13 19
RECIPIENT*
Mean Age (y) 52 56 54 57
% Age 65+ 17 28 .02 22 33 ns
% EPTS 80+ 15 21 ns 29 17 .04
BMI Ave 29 30 30 30
% BMI 30+ 46 51 ns 56 48 ns
% Pre-emptive 29 23 ns 9 31 .01
DONOR*
Mean Age (y) 41 46 43 49
% Age 65+ 6 10 ns 8 12 ns
% KDPI 85+ 8 22 .01 9 30 .01
Ave KDPI .43 .58 .47 .65
% ECD 25 35 .02 33 38 ns
% DCD 13 37 .01 33 40 ns
% ECD & DCD 0 8 .01 4 11 ns
Ischemia Ave (hr) 17 20 19 21
% Ischemia 24+ 15 28 .01 21 31 ns
% PHS high risk 8 27 .01 22 30 ns
% HCV 0 17 .01 4 25 .05
% Import 2 31 .01 23 37 .04
% Dual 0 7 .01 3 10 ns
% Mates 26 22 ns 13 27 .02
% Pump 31 44 .01 31 52 .01
OUTCOMES*
% Primary Non Function 3 4 ns 5 3 ns
% DGF 6 15 .01 13 16 ns
LOS ave (d) 6 7 8 6
Mean follow-up (m) 87 21 39 10
*Deceased donor transplants only

After the KAS, significantly more 65+ year old and more obese patients were listed. Transplant numbers increased with significantly more older recipients, and with more imported, KDPI 85+, high risk, HCV+ kidney donors. Kidneys were pumped more often, and ischemia times were longer leading to more DGF. These changes were accentuated 3 years after the KAS when significantly even more KDPI 85+ donors, due mostly to more HCV+, and more pre-emptive transplants were performed; there were also increased donor imports and pumped kidneys. There was no difference in graft and patient survival.

*Conclusions: Listing and transplanting older recipients and accepting more marginal kidneys significantly increased number of transplants without compromising patient and graft survival.

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To cite this abstract in AMA style:

Africa J, King R, Lipscomb L, Patel A, Jones A. Maximizing Utilization of Marginal Kidneys in a Small, Geographically Isolated Transplant Program: 10 Year Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/maximizing-utilization-of-marginal-kidneys-in-a-small-geographically-isolated-transplant-program-10-year-experience/. Accessed May 10, 2025.

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