Document Type
Article
Publication Date
12-18-2024
Abstract
BACKGROUND: Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.
METHODS: We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and "other"-kidney, simultaneous "other" kidney (n = 73).
RESULTS: Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs.
CONCLUSIONS: This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation.
Recommended Citation
Altshuler, Peter J.; Bodzin, Adam S.; Andreoni, Kenneth A.; Singh, Pooja; Yadav, Anju; Glorioso, Jaime M.; Shah, Ashesh P.; Ramirez, Carlo B.; Maley, Warren R.; and Frank, Adam M., "Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States" (2024). Department of Surgery Faculty Papers. Paper 278.
https://jdc.jefferson.edu/surgeryfp/278
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
39703726
Language
English
Included in
Health Services Research Commons, Surgery Commons, Surgical Procedures, Operative Commons
Comments
This article is the author's final published version in Transplantation Direct, Volume 11, Issue 1, December 2024, Pages e1744.
The published version is available at https://doi.org/10.1097/TXD.0000000000001744.
Copyright © 2024 The Author(s)