Poor organ quality and donor-recipient age mismatch rather than poor donation rates account for the decrease in deceased kidney transplantation rates in a Germany Transplant Center

Abstract

SummaryKidney transplantation is limited not by technical or immunological challenges but by lack of donor organs. Whereas the number of patients on waiting list increased, the transplantation rate decreased. We analyzed the development of decline rates and reasons as well as the fate of declined organs. In total, 1403 organs offered to 1950 patients between 2001 and 2010 were included. Of 440 organs offered between 2009 and 2011 that were declined, we investigated whether these organs were transplanted elsewhere and requested delayed graft function, creatinine, graft and patient survival. Data were compared to results of transplantations at the same time at our center. Decline rate increased from 47% to 87%. Main reasons were poor organ quality and donor-recipient age or size mismatch. Of the rejected organs, 55% were transplanted at other centers with function, graft and patient survival equivalent to patients transplanted at our center during that period. The number of decline has increased over time mainly due to a growing number of marginal donors accounting for poor organ quality or a mismatch of donor and recipient. If proper donor-recipient selection is performed, many organs that would otherwise be discarded can be transplanted successfully.

Influence of Deceased Donor and Pretransplant Recipient Parameters on Early Overall Kidney Graft-Survival in Germany

“…Another cofounder can be the assessment of graft-quality as reduced (medium or poor) by the procurement surgeon. But this is always subjective and therefore associated with limitations in validity [ 1 ] because such grafts are discarded by some centres whereas others transplant them with success [ 2 – 4 , 24 – 27 ]. The authors expect that by improved quality of the donation-allocation-transplantation process risk factors like graft-quality, donor maintenance, or laboratory parameters may become negligible.…”

“…A limitation of the study is the short follow-up period, but when implementing the concept of mandatory quality assurance in medicine prospectively by law it was decided to follow up recipients only for three years. In the future, such programs should include longer follow-up periods within a transplant registry as requested by others [ 2 , 4 ]. However, this study contributes important knowledge on how to merge multiple institutional databases without conflict of interests and with protection of patient rights.…”

“…German data beyond the scope of single-center experience were not available until now. Thereby recent studies [ 2 – 4 ] concluded that many grafts assumed to be marginal can be used for KTX with appropriate graft-survival. The authors requested that their results should be confirmed through analysis of the national data by a currently not existing scientific registry [ 2 , 4 ].…”

“…Thereby recent studies [ 2 – 4 ] concluded that many grafts assumed to be marginal can be used for KTX with appropriate graft-survival. The authors requested that their results should be confirmed through analysis of the national data by a currently not existing scientific registry [ 2 , 4 ]. With regard to the German donor and recipient population factors which determine the outcome of KTX should be analysed as recently done in heart and liver transplantation [ 5 – 8 ].…”

Machine Perfusion of Extended Criteria Donor Organs: Immunological Aspects

“…MP is a promising tool to reduce the gap between organ demand and supply that is resulting in a dramatic prolongation in waiting times and associated with increased morbidity and mortality for patients on the waiting list for Tx (16). In an effort to counter this trend, organ allografts that would have previously been deemed unsuitable are nowadays more frequently used for Tx (12) including donation after circulatory death (DCD) and ECD (aged ≥ 60 years or aged 50-59 years with vascular comorbidities) organs (12,17,18).…”