Recipient Selection and Outcomes After Out-of-Sequence Kidney Allocation Since Implementation of Kidney Allocation...

Area of Science:

• Nephrology
• Transplantation
• Organ Allocation

Background:

• Allocation out of sequence (AOOS) kidney transplants have increased, raising concerns about equity and transparency.
• Limited data exists on recipient selection and outcomes for AOOS kidneys at individual transplant centers.

Purpose of the Study:

• To evaluate recipient selection and transplant outcomes for AOOS kidneys at a single center.
• To compare AOOS kidney recipients with those receiving non-AOOS kidneys.

Main Methods:

• Retrospective single-center study of adult deceased donor kidney transplants (March 2021 - March 2024).
• Comparison of AOOS kidney recipients versus non-AOOS kidney recipients.
• Assessment of donor/recipient characteristics, delayed graft function, graft function, and patient/graft survival.

Main Results:

• 17.9% of 498 kidney transplants involved AOOS kidneys.
• AOOS kidneys had higher terminal creatinine and longer cold ischemia times.
• AOOS recipients were older, more often preemptive, and had shorter waiting times; no differences in sex or race.
• Four-year patient and graft survival were not statistically different between AOOS and non-AOOS groups.

Conclusions:

• Transplantation of AOOS kidneys at this center involved specific recipient selection criteria.
• AOOS kidney transplantation did not compromise 4-year patient or graft survival.
• AOOS kidney allocation did not negatively impact gender or racial balance in recipients.