Kidney allograft offers: Predictors of turndown and the impact of late organ acceptance on allograft survival.

Cohen, J B; Shults, J; Goldberg, D S; Abt, P L; Sawinski, D L; Reese, P P

Cohen, J B; Shults, J; Goldberg, D S; Abt, P L; Sawinski, D L; Reese, P P.

Afiliación

Cohen JB; Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA.
Shults J; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Goldberg DS; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Abt PL; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Sawinski DL; Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.
Reese PP; Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Am J Transplant ; 18(2): 391-401, 2018 02.

Article en En | MEDLINE | ID: mdl-28758329

RESUMEN

There is growing interest in understanding patterns of organ acceptance and reducing discard. Little is known about how donor factors, timing of procurement, and geographic location affect organ offer decisions. We performed a retrospective cohort study of 47 563 deceased donor kidney match-runs from 2007 to 2013. Several characteristics unrelated to allograft quality were independently associated with later acceptance in the match-run: Public Health Service increased-risk donor status (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 2.29-2.69), holiday or weekend procurement (aOR 1.11, 95% CI 1.07-1.16), shorter donor stature (aOR 1.53 for <150 cm vs reference >180 cm, 95% CI 1.28-1.94), and procurement in an area with higher intensity of market competition (aOR 1.71, 95% CI 1.62-1.78) and with the longest waiting times (aOR 1.41, 95% CI 1.34-1.49). Later acceptance in the match-run was associated with delayed graft function but not all-cause allograft failure (adjusted hazard ratio 1.01, 95% CI 0.96-1.07). Study limitations include a lack of match-run data for discarded organs and the possibility of sequence inaccuracies for some nonlocal matches. Interventions are needed to reduce turndowns of viable organs, especially when decisions are driven by infectious risk, weekend or holiday procurement, geography, or other donor characteristics unrelated to allograft quality.

Asunto(s)

Aloinjertos/estadística & datos numéricos; Selección de Donante; Supervivencia de Injerto; Fallo Renal Crónico/cirugía; Trasplante de Riñón/métodos; Donantes de Tejidos/estadística & datos numéricos; Obtención de Tejidos y Órganos/estadística & datos numéricos; Adolescente; Adulto; Femenino; Estudios de Seguimiento; Tasa de Filtración Glomerular; Humanos; Pruebas de Función Renal; Masculino; Persona de Mediana Edad; Pronóstico; Sistema de Registros; Estudios Retrospectivos; Factores de Riesgo; Obtención de Tejidos y Órganos/normas; Adulto Joven

Palabras clave

clinical research/practice; donors and donation: deceased; ethics and public policy; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ acceptance; organ allocation; organ procurement and allocation; waitlist management

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Donantes de Tejidos / Obtención de Tejidos y Órganos / Trasplante de Riñón / Selección de Donante / Aloinjertos / Supervivencia de Injerto / Fallo Renal Crónico Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

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