Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States
Background. Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients. Methods. We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001744 |
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| author | Peter J. Altshuler, MD Adam S. Bodzin, MD Kenneth A. Andreoni, MD Pooja Singh, MD Anju Yadav, MD Jaime M. Glorioso, MD Ashesh P. Shah, MD Carlo Gerado B. Ramirez, MD Warren R. Maley, MD Adam M. Frank, MD |
| author_facet | Peter J. Altshuler, MD Adam S. Bodzin, MD Kenneth A. Andreoni, MD Pooja Singh, MD Anju Yadav, MD Jaime M. Glorioso, MD Ashesh P. Shah, MD Carlo Gerado B. Ramirez, MD Warren R. Maley, MD Adam M. Frank, MD |
| author_sort | Peter J. Altshuler, MD |
| collection | DOAJ |
| description | Background. Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.
Methods. We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and “other”-kidney, simultaneous “other” kidney (n = 73).
Results. Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs.
Conclusions. This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation. |
| format | Article |
| id | doaj-art-8c3e0b7fc6ea41fcb8bf0b0d7bcbd98e |
| institution | Kabale University |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-8c3e0b7fc6ea41fcb8bf0b0d7bcbd98e2024-12-24T09:47:19ZengWolters KluwerTransplantation Direct2373-87312025-01-01111e174410.1097/TXD.0000000000001744202501000-00008Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United StatesPeter J. Altshuler, MD0Adam S. Bodzin, MD1Kenneth A. Andreoni, MD2Pooja Singh, MD3Anju Yadav, MD4Jaime M. Glorioso, MD5Ashesh P. Shah, MD6Carlo Gerado B. Ramirez, MD7Warren R. Maley, MD8Adam M. Frank, MD91 Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.3 Department of Medicine, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, PA.3 Department of Medicine, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.2 Department of Surgery, Division of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA.Background. Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients. Methods. We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and “other”-kidney, simultaneous “other” kidney (n = 73). Results. Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs. Conclusions. This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001744 |
| spellingShingle | Peter J. Altshuler, MD Adam S. Bodzin, MD Kenneth A. Andreoni, MD Pooja Singh, MD Anju Yadav, MD Jaime M. Glorioso, MD Ashesh P. Shah, MD Carlo Gerado B. Ramirez, MD Warren R. Maley, MD Adam M. Frank, MD Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States Transplantation Direct |
| title | Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States |
| title_full | Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States |
| title_fullStr | Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States |
| title_full_unstemmed | Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States |
| title_short | Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States |
| title_sort | deceased donor renal allograft utility in adult single and multi organ transplantation in the united states |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001744 |
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