Quantification of Center Aggressiveness in Accepting Sub-Optimal Kidney Donations from Deceased Donors in the US

T. P. Chiang¹, M. Eagleson¹, A. Massie¹, M. Krach¹, D. Segev¹, J. Garonzik Wang²

¹Department of Surgery, Johns Hopkins University, Baltimore, MD, ²School of Medicine and Public Health, University of Wisconsin, Madison, WI

Meeting: 2022 American Transplant Congress

Abstract number: 313

Keywords: Donors, marginal, Kidney transplantation, Organ Selection/Allocation, Resource utilization

Topic: Clinical Science » Kidney » 50 - Health Equity and Access

Session Information

Session Name: Health Equity and Access I

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

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

Presentation Time: 6:40pm-6:50pm

Location: Hynes Ballroom C

*Purpose: Understanding center-level differences in usage of marginal deceased-donor kidneys (suboptimal kidneys, SOK) can help centers increase their deceased-donor transplant rate (DDKT), and to direct SOK offers to centers willing to accept them.

*Methods: We studied 5,646,748 offers of 8,539 SOK donors from 1/1/2018-12/31/2019 using SRTR data. Pediatric centers, center annual volume<1, or multiple match-runs were excluded. We defined SOK offer as: age>60, cold ischemia time (CIT)>24 hours, hepatitis C (HCV), serum creatinine (SCr)>2.0 mg/dL, donated after cardiac death (DCD), KDPI>85, or infectious risk donors (IRD). We used multilevel logistic regression to calculate the median odds ratio (MOR), a measure of center-level variation, for each subtype of SOK.

*Results: There were 18,471 (64%) SOK among 28,676 DDKT performed. Among 197 centers, the percentage of SOK acceptance ranged from 0 to 44.7% with the median (IQR) of 10.6% (6.9%, 14.6%). The SOK subtype with the least center-level variance was DCD (acceptance range: 0-95%, median [IQR]: 10.2% [6.4%, 15.9%], MOR=2.11) and IRD (acceptance range: 0-63.6%, median [IQR]: 16.0% [9.2%, 22.5%], MOR=2.11). The SOK subtype with the most center-level variance was CIT>24 (acceptance range: 0-55.1%, median [IQR]: 2.7% [0.8%, 6.6%], MOR=3.15). For comparison, the MOR of non-SOK kidneys was 1.90.

Numbers of DDKT Donors, Offers and MOR by SOK Category
results	transplants performed	eligible donors	median (IQR) # of offers per donor	median (IQR) acceptance rate by center	MOR
age>60	1814	822	289 (41, 1129)	4.8 % (1.8 %, 8.5 %)	2.30
CIT>24 H	3031	1179	140 (8, 1204)	2.7 % (0.8 %, 6.6 %)	3.15
HCV (+)	2483	1023	13 (5, 61)	10.5 % (2.9 %, 20.4 %)	2.70
SCr>2.0	4005	1675	93 (12, 512)	7.6 % (3.2 %, 13.3 %)	2.51
DCD	7173	3260	23 (6, 254)	10.2 % (6.4 %, 15.9 %)	2.11
KDPI>85	2629	1170	310 (64, 1220)	3.5 % (1.1 %, 6.9 %)	2.57
IRD	7809	659	12 (5, 69)	16 % (9.2 %, 22.5 %)	2.11

*Conclusions: There was substantial center-level variation in acceptances of SOK offers for each of the SOK subtype categories. Informing centers of donor phenotypes for which that center’s acceptance rate is lower than the national average may motivate centers to accept more marginal kidneys, improving access to DDKT for patients at those centers.

To cite this abstract in AMA style:

Chiang TP, Eagleson M, Massie A, Krach M, Segev D, Wang JGaronzik. Quantification of Center Aggressiveness in Accepting Sub-Optimal Kidney Donations from Deceased Donors in the US [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/quantification-of-center-aggressiveness-in-accepting-sub-optimal-kidney-donations-from-deceased-donors-in-the-us/. Accessed May 30, 2025.

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