Recipient Selection and Outcomes After Out-of-Sequence Kidney Allocation Since Implementation of Kidney Allocation System 250 (KAS250): A Single-Center Experience

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-08-13 DOI:10.1111/ctr.70647

Sandesh Parajuli, Glen E. Leverson, Didier Mandelbrot, Dixon B. Kaufman

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引用次数: 0

Abstract

Introduction

Allocation out of sequence (AOOS) of kidneys has increased after KAS250 and raised concerns regarding transparency and equitable recipient selection. Less is known about recipient selection and outcomes at individual centers.

Methods

We performed a single-center retrospective study of adult deceased donor kidney transplants at the University of Wisconsin from March 15, 2021, to March 31, 2024. Recipients receiving kidneys classified as AOOS were compared with contemporaneous recipients of non-AOOS kidneys. Donor and recipient characteristics, delayed graft function, graft function, and patient and graft survival were assessed. Standardized data explaining why kidneys entered AOOS allocation were unavailable.

Results

Among 498 deceased donor kidney transplant recipients, 89 (17.9%) received AOOS classified kidneys. Donor characteristics were largely similar, although kidneys categorized as AOOS had higher terminal creatinine (1.6 vs. 1.2 mg/dl, p = 0.03) and longer cold ischemia time (22.9 vs. 20.4 h, p = 0.003). AOOS recipients were older, more often preemptive, had shorter waiting times, and were less likely to be retransplant recipients or have cPRA > 20%. Recipient sex and race did not differ. Four-year adjusted patient survival (aHR 0.85; 95% CI 0.38–1.94; p = 0.71) and graft survival (aHR 0.72; 95% CI 0.34–1.54; p = 0.40) were not statistically different.

Conclusion

In this single-center experience, transplantation of kidneys categorized as AOOS was associated with distinct recipient selection, comparable 4-year outcomes, and without compromising gender/racial balance.

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自实施肾脏分配系统250 （KAS250）以来，无序肾脏分配后的受体选择和结果：单中心经验

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.