The number of patients on the wait list for a kidney transplant is increasing, yet the discard rate of donated kidneys remains high. There are data available from the United Network for Organ Sharing (UNOS) and Scientific Registry of Transplant Recipients (SRTR) databases on hard-to-place kidneys (HTPKs). HTPKs are defined as allografts allocated and transplanted after initial 100 offers.

D. Bahl and colleagues conducted an outcomes analysis study of centers performing high volumes of transplants using HTPKs; the analysis was also designed to provide a trends analysis for centers deemed as high volume in the previous data cycle. Results were reported during a virtual presentation at the American Transplant Congress 2020 in a presentation titled Outcomes Analysis of Transplant Centers Performing High Volumes of Hard to Place Kidneys: An Update.

Centers identified as high volume HTPK facilities were defined as those that performed more than 30 HTPK transplants per year. Data on both patient and graft survival were available. The analysis included transplants performed from January 1, 2018, to December 31, 2018; the outcomes analysis included the period January 1, 2016, to December 31, 2018. Data were compared with the time period January 1, 2017, to December 31, 2017.

During the specified study period, a total of 1888 HTPK transplants were performed. Only 19 of 223 of all transplant centers in the United States performed high volume HTPK transplants. Those 19 centers accounted for 60% (n=1080/1888) of HTPK transplants. Outcomes at six of the 19 centers (31.6%) were as expected, six had below expected outcomes (31.6%), and seven had outcomes above expected (36.8%).

In analysis of HTPK center locations by UNOS regions, region 9 had six of the 19 (32%), region 5 had five of the 19 (26%), and regions 2, 4, and 11 each had two centers (11% each). Regions 3 and 8 each had one center (5% each). New York, California, and Arizona accounted for 58% of the HTPK centers.

In summary, the researchers said, “Our study demonstrated that only 8.5% of all US transplant centers are high volume utilizers of HTPK. Our study locates over 70% of such centers in four states: Arizona, California, Florida, and New York. Sixty-eight percent of the HTPK centers had acceptable outcomes or better, and best practice [data] at these centers are being captured by our ongoing study.

“Region 9 and region 5 continue to transplant the highest number of HTPKs and transplant more than 50% of all HTPKs. Analyzing these centers’ practices is imperative to understand how to better allocate kidneys with expected outcomes or better. As new organ allocation policies are formulated, center preference needs to be captured in more granularity to identify centers likely to accept a HTPK.

“Our study suggests when new allocation policies are formulated, algorithms be considered specifically for organs likely to be classified as HTPK and center experience be factored. Expedited offers to such centers would increase the utilization and reduce discard.”

Source: Bahl D, Mehta N, Qazi YA. Outcomes analysis of transplant centers preforming high volumes of hard to place kidneys: An update. Abstract of a presentation at the virtual American Transplant Congress 2020 (Abstract 230), May 30, 2020.

Credit: Original article published here.