title: Predictors of Deceased Donor Kidney Discard in the United States.
abstract: Renal transplantation is a lifesaving intervention for end-stage renal disease. The demand for renal transplantation outweighs the availability of organs; however, up to 20% of recovered kidneys are discarded before transplantation. We aimed to better characterize the risk factors for deceased donor kidney discard.
  
  
  
  We performed a secondary analysis of the Organ Procurement and Transplantation Network database from 2000 to 2012 of all solid organ donors. The cohort was split into training (80%) and validation (20%) subsets. We performed a stepwise logistic regression to develop a multivariate risk prediction model for kidney graft discard and validated the model. The performance of the models was evaluated with respect to calibration, and area under the curve (AUC) of receiver operating characteristic curves.
  
  
  
  There were no significant baseline differences between the training (n = 57 474) and validation (n = 14 368) cohorts. The multivariate model validation showed very good discriminant function in predicting kidney discard (AUC = 0.84). Predictors of increased discard included age older than 50 years, performance of a kidney biopsy, cytomegalovirus seropositive status, donation after cardiac death, hepatitis B and C seropositive status, cigarette use, diabetes, hypertension, terminal creatinine greater than 1.5 mg/dL and AB blood type. The model outperformed the Kidney Donor Risk Index in predicting discard (P < 0.001). Subgroup analysis of expanded criteria donor kidneys demonstrated good discrimination with an AUC of 0.70.
  
  
  
  We have characterized several important predictors of deceased donor kidney discard. Better understanding of factors that lead to increased deceased donor kidney discard can allow for targeted interventions to reduce discard.
authors.affiliation: 1 Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI. 2 Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 3 Comprehensive Transplant Center, Northwestern University, Chicago, IL. 4 School of Public Health, University of Michigan, Ann Arbor, MI. 5 Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI.
authors.forename: Wesley J
authors.initials: WJ
authors.lastname: Marrero
authors.forename: Abhijit S
authors.initials: AS
authors.lastname: Naik
authors.forename: John J
authors.initials: JJ
authors.lastname: Friedewald
authors.forename: Yongcai
authors.initials: Y
authors.lastname: Xu
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
authors.forename: Mariel S
authors.initials: MS
authors.lastname: Lavieri
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002423:Cause of Death; D003661:Decision Support Techniques; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult