Outcomes with transplanting kidneys offered through expedited allocation

Area of Science:

• Nephrology
• Transplantation
• Organ Allocation

Background:

• Expedited out-of-sequence deceased donor kidney allocation aims to reduce organ discards.
• This strategy is employed when initial placement attempts for deceased donor kidneys are unsuccessful.

Purpose of the Study:

• To assess the outcomes and characteristics of kidneys transplanted via expedited allocation (EA).
• To compare EA kidney transplants with standard allocation (SA) kidneys using KDPI matching.

Main Methods:

• Retrospective analysis of deceased donor kidney transplants at a single center from 2018-2021.
• Comparison of expedited allocation (EA) and standard allocation (SA) groups based on donor and recipient characteristics, and post-transplant outcomes.
• Kidney Donor Profile Index (KDPI) matching was used for comparison.

Main Results:

• 189 of 225 (84%) expedited allocation offers were transplanted.
• EA recipients were older and had shorter dialysis vintage compared to SA recipients.
• EA kidneys were more likely to be nationally allocated, from donors with Acute Kidney Injury (AKI), and had longer cold ischemia times (CIT).
• Despite higher rates of delayed graft function (DGF) in EA kidneys, there were no significant differences in DGF duration, hospital stay, or 1- and 2-year eGFR and survival rates between EA and SA groups.

Conclusions:

• Expedited allocation kidneys, often from AKI donors with more DGF, demonstrated similar outcomes to KDPI-matched standard allocation kidneys.
• Transplant center decisions on organ acceptance play a role in organ utilization and may influence transplant disparities.
• EA is an effective strategy for utilizing deceased donor kidneys that might otherwise be discarded.