Purpose: Public Health Service (PHS) criteria designate certain deceased donors (DD) as entailing increased risk (IR) for disease transmission, and these constitute an expanding proportion of organ donors. We sought to determine the association of donor IR status on the discard of kidneys recovered for transplant (KRFT), after controlling for other factors known to affect the decision to discard, and how this differed among regions.

Methods: Scientific Registry of Transplant Recipients (SRTR) data for KRFT (excluding en-bloc transplants) from donors aged 18-75 in regions 1-12 during 1994-2016 were analyzed. Donors meeting IR criteria were identified using PHS definitions (which changed in 2013). KDRI was calculated following OPTN guidelines for donor factors, using 2016 coefficients. Literature review identified other important predictors of discard, including decision to biopsy or pump, and graft glomerulosclerosis (GLOM) >20%. The effects of IR status, KDRI, and other predictors on the probability of discard were estimated using logistic regression, with region included as a random effect.

Results: For all DD KRFT during 1994-2012, 15,811 of 221,021 (7.2%) were from IR donors; during 2013-2016, 12,758 of 60,376 (21.1%) were from IR donors. However, the overall probability of discard has been relatively stable between 18-20% for the last decade. The mean KDRI, frequency of biopsy, and GLOM are significantly lower in KRFT from IR donors compared to non-IR donors. After controlling for these and other factors, the probability of discard for a KRFT during 2013-2016 was greater for IR donors (OR 1.86, 95% CI 1.75-1.98). For both IR and non-IR donors, biopsy and GLOM increased the risk, while pumped KRFT were much less likely to be discarded (OR 0.55, 95% CI 0.52-0.58). After controlling for other factors, odds ratios associated with different regions ranged from 0.76 (95% CI 0.67-0.87) to 1.41 (95% CI 1.30-1.53). Estimated effects in the earlier time period were similar.

Conclusions: DD IR status independently affects the decision to discard KRFT. A closer look at regional differences may allow for more thorough evaluation of current kidney allocation system practices.

CITATION INFORMATION: Lipinska J., Clark D., Whiting J. Temporal Trends, Predictive Factors, and Regional Differences in Discard of Increased-Risk Kidneys Am J Transplant. 2017;17 (suppl 3).

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