Allocating deceased donor using local vs imported renal allografts: logistics are more important than distance
Mahmoudreza Moein1, Praise E. Njoku Austin1, Rauf Shabazov1, Mathew Hanlon1, Alex Almonte1, Oleh Pankewycz1, Mark R. Laftavi1, Reza Saidi1.
1Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
Background: The deceased donor kidney allocation system (KAS) aims to optimize and equalize organ access for candidates nationwide and facilitate organ matching for candidates who are harder to match due to biologic reasons. In March 2021, UNOS implanted a new allocation of KT based on distance from the donor hospitals. A distance within 250 nautical miles will receive additional proximity points to access KT.
Material and Method: This was a retrospective single-center study assessed the Cold ischemic time (CIT) and Delayed graft function (DGF) in allograft kidneys January 2014 to December 2020. We studied 221 import KT and compared the outcomes to locally procured KT (n=160) and finally compared the patients and grafts survival rates in 1-year and 5-years.
Results: Donor and recipient demographics were similar in both groups. Induction and maintenance immunosuppression were similar in both groups. CIT was significantly higher in the imported group (27.6 vs. 15.9 hours, p< 0.0001). However, distance did not impact CIT significantly (R2= 0.07) in the imported KT’s. Distance also did not impact the rate of DGF in both groups (imported 21% vs. 22%, p=0.74). Patient and graft survivals were similar in the imported vs. local group.
Conclusions: We conclude that distance alone has no correlation with CIT and DGF. There are many logistical factors and OPO factors that has significant impact on CIT which should take into consideration.
Keywords: Kidney, Transplant, New allocation, distance, Survival rate.
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