Determinants of discard of expanded criteria donor kidneys: Impact of biopsy and machine perfusion

R. S. Sung, L. L. Christensen, A. B. Leichtman, S. M. Greenstein, D. A. Distant, J. J. Wynn, Mark D Stegall, F. L. Delmonico, F. K. Port

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Abstract

We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12 536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26-0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18-0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.

Original languageEnglish (US)
Pages (from-to)783-792
Number of pages10
JournalAmerican Journal of Transplantation
Volume8
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Perfusion
Tissue Donors
Kidney
Biopsy
Delayed Graft Function
Odds Ratio
Transplants
Logistic Models
Tissue and Organ Procurement
Organ Transplantation
Proportional Hazards Models
Registries

Keywords

  • Biopsy
  • Delayed graft function
  • Discard rates
  • Expanded criteria donors
  • Glomerulosclerosis
  • Graft failure
  • Machine perfusion

ASJC Scopus subject areas

  • Immunology

Cite this

Sung, R. S., Christensen, L. L., Leichtman, A. B., Greenstein, S. M., Distant, D. A., Wynn, J. J., ... Port, F. K. (2008). Determinants of discard of expanded criteria donor kidneys: Impact of biopsy and machine perfusion. American Journal of Transplantation, 8(4), 783-792. https://doi.org/10.1111/j.1600-6143.2008.02157.x

Determinants of discard of expanded criteria donor kidneys : Impact of biopsy and machine perfusion. / Sung, R. S.; Christensen, L. L.; Leichtman, A. B.; Greenstein, S. M.; Distant, D. A.; Wynn, J. J.; Stegall, Mark D; Delmonico, F. L.; Port, F. K.

In: American Journal of Transplantation, Vol. 8, No. 4, 04.2008, p. 783-792.

Research output: Contribution to journalArticle

Sung, RS, Christensen, LL, Leichtman, AB, Greenstein, SM, Distant, DA, Wynn, JJ, Stegall, MD, Delmonico, FL & Port, FK 2008, 'Determinants of discard of expanded criteria donor kidneys: Impact of biopsy and machine perfusion', American Journal of Transplantation, vol. 8, no. 4, pp. 783-792. https://doi.org/10.1111/j.1600-6143.2008.02157.x
Sung, R. S. ; Christensen, L. L. ; Leichtman, A. B. ; Greenstein, S. M. ; Distant, D. A. ; Wynn, J. J. ; Stegall, Mark D ; Delmonico, F. L. ; Port, F. K. / Determinants of discard of expanded criteria donor kidneys : Impact of biopsy and machine perfusion. In: American Journal of Transplantation. 2008 ; Vol. 8, No. 4. pp. 783-792.
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T2 - Impact of biopsy and machine perfusion

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AU - Christensen, L. L.

AU - Leichtman, A. B.

AU - Greenstein, S. M.

AU - Distant, D. A.

AU - Wynn, J. J.

AU - Stegall, Mark D

AU - Delmonico, F. L.

AU - Port, F. K.

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N2 - We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12 536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26-0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18-0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.

AB - We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12 536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26-0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18-0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.

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KW - Discard rates

KW - Expanded criteria donors

KW - Glomerulosclerosis

KW - Graft failure

KW - Machine perfusion

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