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Use of high-risk kidneys varies among transplant centers, shortens time on waitlist
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Newly published findings suggest that while increased utilization of “high-risk” kidneys was associated with shorter time to transplantation, there was substantial variation in acceptance patterns among centers.
“Given the lower risk of death associated with transplantation using any quality organ compared to dialysis, transplant centers’ willingness to use organs with less desirable characteristics results in advantages for their waitlisted candidates via shorter wait times and higher probability of being transplanted,” Corey Brennan, MPH, of Columbia University Irving Medical Center, and colleagues wrote. “Identification of transplant centers that are more willing to accept less than ideal organs would be important for patients to make informed choices about where to receive care given their primary concern being how quickly they will get a transplant. An improved understanding of transplant center practices can also potentially improve the efficiency of the allocation system and help organ procurement organizations limit the rising rate of organ discard.”
To this end, researchers developed a tool — referred to as a “donor utilization index” — to measure the willingness of transplant centers to accept organs with 15 characteristics strongly associated with discard (ie, perceived as high-risk). The index suggested the greatest increase in odds of discard occurred when the donor had hepatitis C (OR = 8.82). Other factors that increased the odds of discard included terminal creatinine of greater than 2 mg/dL (OR = 5.21) and kidney donor profile index of greater than 85% (OR = 3.77).
By estimating the prevalence of these risks in 113,640 deceased donor kidneys transplanted between 2010 and 2016, researchers found that, in practice, donor characteristics associated with discard were not rare among the transplanted kidneys. They argued that this indicates many centers commonly utilize donor kidneys that have some risk (kidneys carrying risk from donor non-IV drug use or death due to stroke were most prevalent, while those with cancer and hepatitis C were least prevalent). In addition, “fairly large” between-center and between-region variation in the proportion of kidneys transplanted with high-risk characteristics was observed.
“It seems clear that different regions have access to differing qualities of kidneys,” the researchers wrote. “General population densities, difference in ESRD prevalence, and demographic breakdowns of each region might explain some of this difference, with certain regions not having a proportionate number of donors to their transplant needs. Organ procurement organizations play a major role in organ procurement and allocation, and as such also meaningfully contribute to these regional differences.
“Given that centers and regions with more liberal utilization are achieving acceptable short-term outcomes for transplanted patients using suboptimal organs, perhaps less aggressive centers and regions should be encouraged to emulate such utilization and transplant more patients on their waitlists,” they concluded. – by Melissa J. Webb
Disclosures: Brennan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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