title: Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion.
abstract: We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12,536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26-0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18-0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.
authors.affiliation: Scientific Registry of Transplant Recipients, Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. rssung@umich.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Sung
authors.forename: L L
authors.initials: LL
authors.lastname: Christensen
authors.forename: A B
authors.initials: AB
authors.lastname: Leichtman
authors.forename: S M
authors.initials: SM
authors.lastname: Greenstein
authors.forename: D A
authors.initials: DA
authors.lastname: Distant
authors.forename: J J
authors.initials: JJ
authors.lastname: Wynn
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
authors.forename: F L
authors.initials: FL
authors.lastname: Delmonico
authors.forename: F K
authors.initials: FK
authors.lastname: Port
mesh_terms: D001706:Biopsy; D002102:Cadaver; D003643:Death; D006801:Humans; D007668:Kidney / Q000166:cytology / Q000473:pathology; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008099:Liver; D016031:Liver Transplantation / Q000706:statistics & numerical data; D019520:Living Donors / Q000600:supply & distribution; D018579:Patient Selection; D010477:Perfusion / Q000379:methods; D012042:Registries; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists