Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys

Randall S. Sung, Mary K. Guidinger, Craig D. Lake, Maureen A. McBride, Stuart M. Greenstein, Francis L. Delmonico, Friedrich K. Port, Robert M. Merion, Alan B. Leichtman

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background. The U.S. Organ Procurement and Transplantation Network recently implemented a policy allocating expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined as having a risk of graft failure ≥1.7 times that of ideal donors. ECDs include any donor ≥60 years old and donors 50 to 59 years old with at least two of the following: terminal creatinine >1.5 mg/dL, history of hypertension, or death by cerebrovascular accident. The impact of this policy on use of ECD kidneys is assessed. Methods. The authors compared use of ECD kidneys recovered in the 18 months immediately before and after policy implementation. Differences were tested using t test and χ2 analyses. Results. There was an 18.3% increase in ECD kidney recoveries and a 15.0% increase in ECD kidney transplants in the first 18 months after policy implementation. ECD kidneys made up 22.1% of all recovered kidneys and 16.8% of all transplants, compared with 18.8% (P<0.001) and 14.5% (P<0.001), respectively, in the prior period. The discard rate was unchanged. The median relative risk (RR) for graft failure for transplanted ECD kidneys was 2.07 versus 1.99 in the prepolicy period (P=not significant); the median RR for procured ECD kidneys was unchanged at 2.16. The percentage of transplanted ECD kidneys with cold ischemia times (CIT) <12 hr increased significantly; the corresponding percentage for CIT ≥24 hr decreased significantly. Conclusions. The recent increase in ECD kidney recoveries and transplants appears to be related to implementation of the ECD allocation system.

Original languageEnglish (US)
Pages (from-to)1257-1261
Number of pages5
JournalTransplantation
Volume79
Issue number9
DOIs
StatePublished - May 15 2005

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Kidney
Transplants
Cold Ischemia
Tissue and Organ Procurement
Organ Transplantation
Creatinine
Stroke
Hypertension

Keywords

  • Expanded-criteria donors
  • Kidney transplantation
  • Organ allocation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Sung, R. S., Guidinger, M. K., Lake, C. D., McBride, M. A., Greenstein, S. M., Delmonico, F. L., ... Leichtman, A. B. (2005). Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys. Transplantation, 79(9), 1257-1261. https://doi.org/10.1097/01.TP.0000161225.89368.81

Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys. / Sung, Randall S.; Guidinger, Mary K.; Lake, Craig D.; McBride, Maureen A.; Greenstein, Stuart M.; Delmonico, Francis L.; Port, Friedrich K.; Merion, Robert M.; Leichtman, Alan B.

In: Transplantation, Vol. 79, No. 9, 15.05.2005, p. 1257-1261.

Research output: Contribution to journalArticle

Sung, RS, Guidinger, MK, Lake, CD, McBride, MA, Greenstein, SM, Delmonico, FL, Port, FK, Merion, RM & Leichtman, AB 2005, 'Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys', Transplantation, vol. 79, no. 9, pp. 1257-1261. https://doi.org/10.1097/01.TP.0000161225.89368.81
Sung, Randall S. ; Guidinger, Mary K. ; Lake, Craig D. ; McBride, Maureen A. ; Greenstein, Stuart M. ; Delmonico, Francis L. ; Port, Friedrich K. ; Merion, Robert M. ; Leichtman, Alan B. / Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys. In: Transplantation. 2005 ; Vol. 79, No. 9. pp. 1257-1261.
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abstract = "Background. The U.S. Organ Procurement and Transplantation Network recently implemented a policy allocating expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined as having a risk of graft failure ≥1.7 times that of ideal donors. ECDs include any donor ≥60 years old and donors 50 to 59 years old with at least two of the following: terminal creatinine >1.5 mg/dL, history of hypertension, or death by cerebrovascular accident. The impact of this policy on use of ECD kidneys is assessed. Methods. The authors compared use of ECD kidneys recovered in the 18 months immediately before and after policy implementation. Differences were tested using t test and χ2 analyses. Results. There was an 18.3{\%} increase in ECD kidney recoveries and a 15.0{\%} increase in ECD kidney transplants in the first 18 months after policy implementation. ECD kidneys made up 22.1{\%} of all recovered kidneys and 16.8{\%} of all transplants, compared with 18.8{\%} (P<0.001) and 14.5{\%} (P<0.001), respectively, in the prior period. The discard rate was unchanged. The median relative risk (RR) for graft failure for transplanted ECD kidneys was 2.07 versus 1.99 in the prepolicy period (P=not significant); the median RR for procured ECD kidneys was unchanged at 2.16. The percentage of transplanted ECD kidneys with cold ischemia times (CIT) <12 hr increased significantly; the corresponding percentage for CIT ≥24 hr decreased significantly. Conclusions. The recent increase in ECD kidney recoveries and transplants appears to be related to implementation of the ECD allocation system.",
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AU - Sung, Randall S.

AU - Guidinger, Mary K.

AU - Lake, Craig D.

AU - McBride, Maureen A.

AU - Greenstein, Stuart M.

AU - Delmonico, Francis L.

AU - Port, Friedrich K.

AU - Merion, Robert M.

AU - Leichtman, Alan B.

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N2 - Background. The U.S. Organ Procurement and Transplantation Network recently implemented a policy allocating expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined as having a risk of graft failure ≥1.7 times that of ideal donors. ECDs include any donor ≥60 years old and donors 50 to 59 years old with at least two of the following: terminal creatinine >1.5 mg/dL, history of hypertension, or death by cerebrovascular accident. The impact of this policy on use of ECD kidneys is assessed. Methods. The authors compared use of ECD kidneys recovered in the 18 months immediately before and after policy implementation. Differences were tested using t test and χ2 analyses. Results. There was an 18.3% increase in ECD kidney recoveries and a 15.0% increase in ECD kidney transplants in the first 18 months after policy implementation. ECD kidneys made up 22.1% of all recovered kidneys and 16.8% of all transplants, compared with 18.8% (P<0.001) and 14.5% (P<0.001), respectively, in the prior period. The discard rate was unchanged. The median relative risk (RR) for graft failure for transplanted ECD kidneys was 2.07 versus 1.99 in the prepolicy period (P=not significant); the median RR for procured ECD kidneys was unchanged at 2.16. The percentage of transplanted ECD kidneys with cold ischemia times (CIT) <12 hr increased significantly; the corresponding percentage for CIT ≥24 hr decreased significantly. Conclusions. The recent increase in ECD kidney recoveries and transplants appears to be related to implementation of the ECD allocation system.

AB - Background. The U.S. Organ Procurement and Transplantation Network recently implemented a policy allocating expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined as having a risk of graft failure ≥1.7 times that of ideal donors. ECDs include any donor ≥60 years old and donors 50 to 59 years old with at least two of the following: terminal creatinine >1.5 mg/dL, history of hypertension, or death by cerebrovascular accident. The impact of this policy on use of ECD kidneys is assessed. Methods. The authors compared use of ECD kidneys recovered in the 18 months immediately before and after policy implementation. Differences were tested using t test and χ2 analyses. Results. There was an 18.3% increase in ECD kidney recoveries and a 15.0% increase in ECD kidney transplants in the first 18 months after policy implementation. ECD kidneys made up 22.1% of all recovered kidneys and 16.8% of all transplants, compared with 18.8% (P<0.001) and 14.5% (P<0.001), respectively, in the prior period. The discard rate was unchanged. The median relative risk (RR) for graft failure for transplanted ECD kidneys was 2.07 versus 1.99 in the prepolicy period (P=not significant); the median RR for procured ECD kidneys was unchanged at 2.16. The percentage of transplanted ECD kidneys with cold ischemia times (CIT) <12 hr increased significantly; the corresponding percentage for CIT ≥24 hr decreased significantly. Conclusions. The recent increase in ECD kidney recoveries and transplants appears to be related to implementation of the ECD allocation system.

KW - Expanded-criteria donors

KW - Kidney transplantation

KW - Organ allocation

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