Abstract: FR-OR085
Deceased Donor Kidney Utilization and Outcomes Across Three Nationwide Allocation Systems: A 15-Year Analysis of More Than 400,000 Recovered Kidneys
Session Information
- The Changing Landscape of Kidney Transplantation: Clinical Innovation, Outcomes, and Health Policy
October 23, 2026 | Location: Mile High Ballroom 4A, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Juric, Ivana, INSERM, Paris, Île-de-France, France
- Audry, Benoit, Agence de la Biomedecine, Saint-Denis, Île-de-France, France
- Brousse, Romain H J, INSERM, Paris, Île-de-France, France
- Truchot, Agathe, INSERM, Paris, Île-de-France, France
- Raynaud, Marc, INSERM, Paris, Île-de-France, France
- Thalamas, Thibaut, INSERM, Paris, Île-de-France, France
- Tieken, Ineke, Eurotransplant, Leiden, Netherlands
- Jacquelinet, Christian, Agence de la Biomedecine, Saint-Denis, Île-de-France, France
- Reese, Peter P., Vanderbilt University, Nashville, Tennessee, United States
- Loupy, Alexandre, INSERM, Paris, Île-de-France, France
Group or Team Name
- Paris Institute for Transplantation and Organ Regeneration
Background
Despite the persistent organ shortage, a substantial proportion of deceased donor kidneys recovered for transplantation are discarded. We previously showed the US discard rate was nearly twice that of France in 2004-2014. Since then, changes in allocation, preservation and donor characteristics, and the COVID-19 pandemic may have reshaped the transplantation landscape. Whether these changes impacted contemporary utilization and international disparities has not been characterized.
Methods
We conducted a multinational cohort study using validated national registries from the US, France and Eurotransplant, including all recovered deceased donor kidneys from Jan 1, 2010 to Dec 31, 2024. We compared discard rates, donor characteristics, and kidney quality across systems, using the 2024 KDRI as common reference scale. Discard probability was modeled by logistic regression and death-censored graft failure by Cox proportional hazards with restricted cubic splines for KDRI.
Results
A total of 407,008 kidneys were recovered (US n=310,320; France n=44,720; Eurotransplant n=51,968). Discard rates diverged over the study period: US rose from 18.3% in 2010 to 29.3% in 2024, Eurotransplant from 8.6% to 12%, while France decreased from 9.1% to 5.6% (Figure). France transplanted higher-risk kidneys than the US and Eurotransplant (median KDRI 1.56, 1.14 and 1.36 respectively; p<0.001). At equivalent kidney quality (KDRI=2.0), modeled probability of discard was 61.5% in the US, 24.4% in Eurotransplant, and 11.7% in France. Across KDRI values France had lower hazard ratios for death-censored graft failure: at KDRI=2, HRs were 1.85 (95% CI 1.72-2.00) in France, 2.24 (2.16-2.33) in the US and 2.44 (2.21-2.69) in Eurotransplant.
Conclusion
At equivalent kidney quality, US discard was up to five-fold higher than in France, yet France had the lowest graft failure risk. These findings identify a substantial share of currently discarded kidneys as a potentially avoidable loss and indicate that more permissive utilization practice could expand the deceased donor pool without compromising outcomes.