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Kidney Week

Abstract: TH-OR130

Recipient Outcome After Declining a Deceased-Donor Kidney Offer

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • 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

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.


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.


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quality (57.2%), recipient illness / unavailability (26.2%), and positive crossmatch (4.8%) with the remaining offers withdrawn (11.8%), largely due to delayed cardiac death.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).


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.