Abstract: FR-PO1117
Discontinuities in Transplant Waiting Times, Allograft Quality, and Post-Transplant Outcomes Associated with Expected Post-Transplant Survival-Based Cutoff for Longevity Matching
Session Information
- Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Joseph, Zachary I., Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Yu, Miko, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Schold, Jesse D., University of Colorado System, Denver, Colorado, United States
- Mohan, Sumit, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
Group or Team Name
- Columbia University Renal Epidemiology (CURE) Lab
Background
In organ allocation, longevity matching is the practice of allocating longer-lasting organs to patients with greater expected post-transplant survival. In kidney transplantation in the U.S., this is implemented using Expected Post-transplant Survival (EPTS) scores: patients with EPTS ≤ 20 receive priority during the allocation of deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20. The impact of this eligibility cutoff on waiting list and post-transplant outcomes remains unclear.
Methods
Using UNOS registry data, we identified adult patients listed for kidney-only transplants from 2015 to 2025 and calculated transplant rates by EPTS at listing. For deceased donor kidney recipients, we performed median regression for KDPI of allograft received and a Cox proportional hazards analysis for the event of graft failure or death, using EPTS at transplant and an indicator for EPTS > 20 as explanatory variables.
Results
Among 331,971 eligible patients, transplant rates were significantly lower for patients with initial EPTS 21–25 versus 16–20 (27.21 vs. 30.05 transplants per 100 patient-years, p<0.001). Among the 108,686 eligible deceased donor kidney recipients, loss of longevity matching eligibility was associated with a 16.2-point increase in median KDPI of allograft received (p<0.001) and a 21% greater hazard of graft failure or death (p<0.005).
Conclusion
The current implementation of longevity matching introduces discontinuities in transplant rates, allograft quality, and post-transplant outcomes for patients with EPTS near 20. These findings support consideration of alternative implementations of longevity matching.
Funding
- NIDDK Support