Kidney Transplant Outcome and Organ Acceptance Practice Pattern: A Nationwide Analyses in the US and France

Completed

Conditions studied: Kidney Failure, Transplant;Failure,Kidney

In brief

Despite the considerable advances in short-term outcomes, kidney transplant recipients continue to suffer from late allograft failure, and little improvement has been made over the past 15 years. The worldwide scarcity of donated kidneys and the decline in the number of living donor transplants have prompted a variety of efforts to expand the organ supply, such as accepting organs from donors who were older or had comorbidities or other injuries. Two major initiatives from the United Network for Organ Sharing (UNOS), the organization responsible for organ allocation in the US, failed to improve the kidney acceptance rate. First, UNOS introduced the Kidney Donor Risk Index (KDRI) for all kidney offers in 2012. The KDRI is a score that predicts survival of deceased donor kidneys based on 10 donor characteristics and was intended to simplify the process of judging organ quality for clinicians. Second, in 2014, UNOS changed the kidney allocation system so that lower-quality kidneys are offered over wider geographic areas. Despite the ongoing severe organ shortage and these allocation initiatives, the number of discarded kidneys rose from 2,127 (14.9%) in 2006 to 3,631 (20%) in 2016. In this context, the experience of transplant programs outside the US could offer novel approaches to making organ utilization more efficient through the examination of the disposition of organs that are usually discarded in the US. This project aims: 1. To evaluate the potential benefit of transplanting kidneys that would have been discarded otherwise in the US 2. Computer simulation models on real life data to estimate the number of kidney transplants that would have taken place using data from a nationwide cohort study in two countries (France, the US); 3. To evaluate the potential gains in allograft survival years that would result in the US from a less restrictive kidney acceptance practice such as the one from France.

Key facts

Study ID

NCT03723668

Run by

Paris Translational Research Center for Organ Transplantation

People needed

94017

Starts

2017-10-09

Expected to finish

2020-03-29

Last updated by the study team

2020-05-01

Who can join

Age: any. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• All consecutive kidneys recovered for the purpose of transplantation from donors deceased from brain death or circulatory death,
• Between January 1, 2004 and December 31, 2014.

You may not qualify if…

• Living renal transplants,
• Multiorgan transplant recipients,
• Kidneys offered to transplant centers but never recovered, and
• Patients with missing data to calculate the KDRI score

Where it is running

• Kidney Transplantation Care at Veteran's Affairs Medical Center — Philadelphia, Pennsylvania, United States
• Paris Transplant Group — Paris, France

Full record on ClinicalTrials.gov

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