title: Effects of High-Risk Kidneys on Scientific Registry of Transplant Recipients Program Quality Reports.
abstract: There is a perception that transplanting high-risk kidneys causes programs to be identified as underperforming, thereby increasing the frequency of discards and diminishing access to transplant. Thus, the Organ Procurement and Transplantation Network (OPTN) has considered excluding transplants using kidneys from donors with high Kidney Donor Profile Index (KDPI) scores (≥0.85) when assessing program performance. We examined whether accepting high-risk kidneys (KDPI ≥0.85) for transplant yields worse outcome evaluations. Despite a clear relationship between KDPI and graft failure and mortality, there was no relationship between a program's use of high-KDPI kidneys and poor performance evaluations after risk adjustment. Excluding high-KDPI donor transplants from the June 2015 evaluations did not alter the programs identified as underperforming, because in every case underperforming programs also had worse-than-expected outcomes among lower-risk donor transplants. Finally, we found that hypothetically accepting and transplanting additional kidneys with KDPI similar to that of kidneys currently discarded would not adversely affect program evaluations. Based on the study findings, there is no evidence that programs that accept higher-KDPI kidneys are at greater risk for low performance evaluations, and risk aversion may limit access to transplant for candidates while providing no measurable benefit to program evaluations.
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: J J
authors.initials: JJ
authors.lastname: Snyder
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: N
authors.initials: N
authors.lastname: Salkowski
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: A
authors.initials: A
authors.lastname: Wey
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.|Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: A K
authors.initials: AK
authors.lastname: Israni
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: B L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D046148:Donor Selection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D011379:Prognosis; D012042:Registries / Q000592:standards*; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D066027:Transplant Recipients
keywords: Organ Procurement and Transplantation Network (OPTN); Scientific Registry for Transplant Recipients (SRTR); clinical research/practice; donors and donation: deceased; kidney transplantation/nephrology; organ acceptance; organ procurement and allocation