Kristen L King1,2, Sulemon G Chaudhry3, Lloyd E Ratner3, David J Cohen1, S Ali Husain1,2, Sumit Mohan1,2,4. 1. Department of Medicine, Columbia University Irving Medical Center, New York, New York. 2. The Columbia University Renal Epidemiology Group, New York, New York. 3. Division of Transplant Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York. 4. Department of Epidemiology, Mailman School of Public Health, New York, New York.
Abstract
Background: Deceased donor kidney offers are frequently declined multiple times before acceptance for transplantation, despite significant organ shortage and long waiting times. Whether the number of times a kidney has been declined, reflecting cumulative judgments of clinicians, is associated with long-term transplant outcomes remains unclear. Methods: In this national, retrospective cohort study of deceased donor kidney transplants in the United States from 2008 to 2015 (n=78,940), we compared donor and recipient characteristics and short- and long-term graft and patient survival outcomes grouping by the sequence number at which the kidney was accepted for transplantation. We compared outcomes for kidneys accepted within the first seven offers in the match-run, after 8-100 offers, and for hard-to-place kidneys distinguishing those requiring >100 and >1000 offers before acceptance. Results: Harder-to-place kidneys had lower donor quality and higher rates of delayed graft function (46% among kidneys requiring >1000 offers before acceptance versus 23% among kidneys with ≤7 offers). In unadjusted models, later sequence groups had higher hazard of all-cause graft failure, death-censored graft failure, and patient mortality; however, these associations were attenuated after adjusting for Kidney Donor Risk Index (KDRI). After adjusting for donor factors already taken into consideration during allocation, and recipient factors associated with long-term outcomes, graft, and patient survival outcomes were not significantly different for the hardest-to-place kidneys compared with the easiest-to-place kidneys, with the exception of death-censored graft failure (adjusted hazard ratio, 1.16, 95% CI, 1.05 to 1.28). Conclusion: Late sequence offers may represent missed opportunities for earlier successful transplant for the higher-priority waitlisted candidates for whom the offers were declined.
Background: Deceased donor kidney offers are frequently declined multiple times before acceptance for transplantation, despite significant organ shortage and long waiting times. Whether the number of times a kidney has been declined, reflecting cumulative judgments of clinicians, is associated with long-term transplant outcomes remains unclear. Methods: In this national, retrospective cohort study of deceased donor kidney transplants in the United States from 2008 to 2015 (n=78,940), we compared donor and recipient characteristics and short- and long-term graft and patient survival outcomes grouping by the sequence number at which the kidney was accepted for transplantation. We compared outcomes for kidneys accepted within the first seven offers in the match-run, after 8-100 offers, and for hard-to-place kidneys distinguishing those requiring >100 and >1000 offers before acceptance. Results: Harder-to-place kidneys had lower donor quality and higher rates of delayed graft function (46% among kidneys requiring >1000 offers before acceptance versus 23% among kidneys with ≤7 offers). In unadjusted models, later sequence groups had higher hazard of all-cause graft failure, death-censored graft failure, and patient mortality; however, these associations were attenuated after adjusting for Kidney Donor Risk Index (KDRI). After adjusting for donor factors already taken into consideration during allocation, and recipient factors associated with long-term outcomes, graft, and patient survival outcomes were not significantly different for the hardest-to-place kidneys compared with the easiest-to-place kidneys, with the exception of death-censored graft failure (adjusted hazard ratio, 1.16, 95% CI, 1.05 to 1.28). Conclusion: Late sequence offers may represent missed opportunities for earlier successful transplant for the higher-priority waitlisted candidates for whom the offers were declined.
Authors: Sumit Mohan; Mariana C Chiles; Rachel E Patzer; Stephen O Pastan; S Ali Husain; Dustin J Carpenter; Geoffrey K Dube; R John Crew; Lloyd E Ratner; David J Cohen Journal: Kidney Int Date: 2018-05-05 Impact factor: 10.612
Authors: Chris J Callaghan; Simon J F Harper; Kourosh Saeb-Parsy; Alex Hudson; Paul Gibbs; Christopher J E Watson; Raaj K Praseedom; Andrew J Butler; Gavin J Pettigrew; J Andrew Bradley Journal: Clin Transplant Date: 2014-02-08 Impact factor: 2.863
Authors: Daniel W Kim; Demetra Tsapepas; Kristen L King; S Ali Husain; Frank A Corvino; Allison Dillon; Weiying Wang; Tracy J Mayne; Sumit Mohan Journal: Clin Transplant Date: 2020-08-11 Impact factor: 2.863
Authors: S Ali Husain; Vaqar Shah; Hector Alvarado Verduzco; Kristen L King; Corey Brennan; Ibrahim Batal; Shana M Coley; Isaac E Hall; M Barry Stokes; Geoffrey K Dube; R John Crew; Adler Perotte; Karthik Natarajan; Dustin Carpenter; P Rodrigo Sandoval; Dominick Santoriello; Vivette D'Agati; David J Cohen; Lloyd Ratner; Glen Markowitz; Sumit Mohan Journal: Kidney Int Rep Date: 2020-08-14
Authors: Sumit Mohan; Karl Foley; Mariana C Chiles; Geoffrey K Dube; Rachel E Patzer; Stephen O Pastan; R John Crew; David J Cohen; Lloyd E Ratner Journal: Kidney Int Date: 2016-05-12 Impact factor: 10.612
Authors: Syed A Husain; Kristen L King; David C Cron; Nikole A Neidlinger; Han Ng; Sumit Mohan; Joel T Adler Journal: Am J Transplant Date: 2022-03-07 Impact factor: 9.369