ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR130

Recipient Outcome After Declining a Deceased-Donor Kidney Offer

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Dosani, Dhriti, Imperial College London, London, United Kingdom
  • Bright, Rupert Benjamin Graham, Imperial College London, London, United Kingdom
  • Adwaney, Anamika, Imperial College London, London, United Kingdom
  • Morganti, Emma C., Imperial College London, London, United Kingdom
  • Ashby, Damien, Imperial College London, London, United Kingdom
Background

The decision to accept a deceased-donor kidney depends on organ quality, and also recipient factors, such as an estimate of mortality on dialysis, and the likelihood of receiving a more favourable offer. Whilst outcome after transplantation has been well studied, with several donor-related risk factors widely accepted, little is known about the outcome after declining a kidney, such as the influence of recipient factors on the chance of subsequent transplantation.

Methods

Over a 12 month period at a single UK centre, all potential recipients were identified for whom a deceased-donor kidney offer was declined, with subsequent transplant outcomes recorded.

Results

Kidneys were declined for 145 patients, aged 24 - 78 (mean 54.1), due to donor / organ quality (57.2%), recipient illness / unavailability (26.2%), and positive crossmatch (4.8%) with the remaining offers withdrawn (11.8%), largely due to delayed cardiac death.
Over a mean follow-up of 12 months, 83 patients (57.2%) received at least one further offer. Second offers tended to be from slightly younger donors (53.5 vs 58.8 years, p=0.103) with the same HLA match (3.2/6 antigens matched).
By the end of observation 59 (40.7%) had been transplanted, 46 (31.7%) remained on the wait-list, 38 (26.2%) were temporarily or permanently suspended from the wait-list, and 2 (1.4%) had died. Compared to those less sensitised, highly sensitised patients (calculated HLA reaction frequency over 75%) were less likely to be transplanted (23.1 vs 47.3%, p=0.025). Older patients (over 60) were more likely to be suspended (39.3 vs 22.0%, p=0.028) with a similar tendency also seen in those waiting over 4 years for their first offer (40.5 vs 25.3%, p=0.082).

Conclusion

After declining a deceased-donor kidney, around 40% of patients may expect to be transplanted during the following year, whilst around 25% may be suspended from the wait-list. Risk factors for suspension or non-transplantation include older age, longer wait-time and greater HLA sensitisation. These data will be helpful to patients and clinicians making kidney offer decisions.