Abstract: FR-PO1045
Practice Variation in PHS-IR Kidney Transplants
Session Information
- Transplantation: Donor-Candidate Assessment and Predictors of Outcome
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Brennan, Corey, Columbia University, New York, New York, United States
- Husain, Syed Ali, Columbia University Medical Center, New York, New York, United States
- Mohan, Sumit, Columbia University, New York, New York, United States
- Chiles, Mariana C., Columbia University Medical Center, New York, New York, United States
Background
There is significant center level practice variation for accepting deceased donor organs in the U.S. We hypothesized that this variation occurs even for kidneys with good outcomes such as those from PHS-IR donors.
Methods
Using data from the Scientific Registry of Transplant Recipients (SRTR) from 2010-2016, we identified 78,087 kidney-alone deceased donor transplant recipients to evaluate transplant center use of PHS-IR organs in the U.S. Additionally, Cox regression analysis was used to assess the difference in allograft outcomes between PHS-IR and non-PHS-IR kidneys.
Results
12,751 (16.3%) of kidneys were procured from PHS-IR donors who were younger (33.1±12.2 vs 38.9±16.5 years), with less hypertension (17.5 vs 29.3%), diabetes (4.1 vs 7.8%), marginally higher terminal SCr (1.31±1.15 vs 1.13±1.06) and lower KDPI (36.7 vs 49.2%) than non-PHS-IR donors (all p<0.001). PHS-IR kidneys demonstrated lower all-cause (12.2 vs 16.7%) and death-censored (5.5 vs 8.2%) graft failure (p<0.001). Despite the objectively higher quality, nearly a third (32.9%) of all PHS-IR kidneys were transplanted by just 10 transplant centers while 20 centers performed no PHS-IR transplants over the 7 year study period (Figure 1). PHS-IR kidneys were also significantly more likely to be shared between OPOs (30.6% vs 23.9%, p<0.001), underscoring the reluctance by some centers to use PHS-IR kidneys. PHS-IR kidneys experienced a reduced risk of graft failure (HR=0.787, p<0.001), persisting even after adjusting for KDPI and EPTS (HR=0.921, p=0.046).
Conclusion
Considerable variation in acceptance of PHS-IR donor kidneys exists despite evidence of the low risk of disease transmission and excellent outcomes. Although the number of potential donors who meet PHS-IR criteria is likely to rise during the opioid epidemic, the reluctance to use these organs is likely to adversely impact organ procurement and kidney discard in the U.S and reaffirms that deceased donors are often declined for factors other than organ quality.
Figure 1.