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Hard‐to‐place kidney offers: Donor‐ and system‐level predictors of discard
Author(s) -
Narvaez J. Reinier F.,
Nie Jing,
Noyes Katia,
Leeman Mary,
Kayler Liise K.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14712
Subject(s) - medicine , kidney , odds ratio , hepatitis b virus , immunology , virus
Understanding risk factors for deceased‐donor kidney nontransplantation is important since discard rates remain high. We analyzed DonorNet ® data of consecutive deceased‐donor nonmandatory share primary kidney‐only offers to adult candidates at our center and beyond between July 1, 2015 and March 31, 2016 for donor‐ and system‐level risk factors of discard, defined as nontransplantation at our or subsequent transplant centers. Exclusions were hepatitis C virus/hepatitis B virus core antibody status, blood type AB , and donor <1 year based on low candidate waitlist size. Of 456 individual kidney offers, from 296 donors, 73% were discarded. Most were national (93%) offers from Kidney Donor Profile Index 35‐85% (n = 233) or >85% (n = 208) donors late in the allocation sequence with prior refusals logged for numerous candidates. On multivariate regression, factors significantly associated with discard were donor cerebrovascular accident (adjusted odds ratio [ aOR ]: 3.32), cancer transmission concern ( aOR : 6.5), renal artery luminal compromise ( aOR : 3.97), biopsy score ≥3 ( aOR : 5.09), 2‐hour pump resistive index >0.4 ( aOR : 3.27), absence of pump ( aOR : 2.58), nonspecific kidney abnormality ( aOR : 2.76), increasing offer cold ischemia time category 11‐15, 16‐20, and >21 hours ( aOR : 2.07, 2.33, 2.82), nighttime notification ( aOR : 2.19), and neither kidney placed at time of offer ( aOR : 2.74). Many traditional determinants of discard lack discriminatory value when granular factors are assessed. System‐level factors also influence discard and warrant further study.