NON-RETRIEVAL AND NON-UTILISATION OF DECEASED DONOR KIDNEYS FOR TRANSPLANTATION: AN AUSTRALIAN COHORT STUDY
Ms Rachel Cutting1, DR NICOLE DE LA MATA1, DR ANIMESH SINGLA2,3, DR JAMES HEDLEY1, HELEN OPDAM4,5, PHILIP CLAYTON6,7,8, KATE WYBURN9,10, ELENA CAVAZZONI11,12, PAUL ROBERTSON13, HENRY PLEASS3,14, ANGELA WEBSTER1,15,16
1Sydney School of Public Health, The University of Sydney, Camperdown, Australia, 2Discipline of Surgery, Sydney Medical School, The University of Sydney, Camperdown, Australia, 3Department of Surgery, Westmead Hospital, Westmead, Australia, 4Organ and Tissue Authority, Australian Government , Canberra, Australia, 5Intensive Care Unit, Austin Hospital, Heidelberg, Australia, 6Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Royal Adelaide Hospital, , Australia, 7Faculty of Health and Medical Science, University of Adelaide, , Australia, 8Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, , Australia, 9Sydney Medical School, The University of Sydney, Camperdown, Australia, 10Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia, 11Department of Paediatric Intensive Care, Children’s Hospital Westmead, Westmead, Australia, 12Organ and Tissue Donation Service, New South Wales Government, Kogarah, Australia, 13Sydney West Area Health Service, Western Sydney Local Health District, , Australia, 14Westmead Clinical School, The University of Sydney, Westmead, Australia, 15National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, Australia, 16Westmead Applied Research Centre, Westmead Hospital, Westmead, Australia
Background: An efficient organ procurement program must maximise utility of retrieval team activity.
Aims: To quantify non-retrieval and non-utilisation rates of deceased donor kidneys.
Methods: We conducted a cohort study of deceased kidney donors in Australia 2014-2021 using ANZOD data. Outcomes were non-retrieval (kidneys not retrieved after surgical incision) and non-utilisation (kidneys retrieved but not transplanted). We compared non-retrieval and non-utilisation rates using logistic regression by donor factors (age, sex, blood-group, ethnicity, BMI, smoking, socio-economic disadvantage, remoteness, year, cause of death, resuscitation, pathway, KDPI, side, dual-allocation/en-bloc), and system factors (state/territory of donor hospital, retrieval team, and intended recipient’s hospital).
Results: Among 7,211 kidneys (3,812 donors) intended for transplantation, 675 (9%) were non-retrieved and 430 (7%) were retrieved but non-utilised. The non-retrieval rate doubled from 5% in 2014 to 10% in 2021 (p=0.01), whereas non-utilisation remained around 7% annually (p=0.1). Non-utilisation rates were lower for donor hospitals in Tasmania (2.3%) and Queensland (3.4%) compared to other states/territories (average 7.5%, p<0.001), and for retrieval teams from Queensland (3.4%) compared to other states/territories (average 7.3%, p=0.004). Factors associated with non-retrieval were KDPI ≥75% for standard criteria donors (OR 3.14, 95%CI: 1.84-5.36) and extended criteria kidneys (OR 3.27, 95%CI: 1.99-5.35, p<0.001), diabetes (OR 1.68, 95%CI: 1.31-2.15, p<0.001) and history of cancer (OR 1.33, 95%CI: 1.01-1.75, p=0.04). Factors associated with non-utilisation were DCDD (OR 1.96, 95%CI: 1.49-2.57, p<0.001), history of cancer (OR 1.49, 95%CI: 1.07-2.05, p=0.02) and older age (OR 1.26, 95%CI: 1.09-1.46, p=0.002). Reasons for non-utilisation included perfusion issues (17%), however most reasons documented lacked transparency.
Conclusions: Efforts to maximise transplantation of donor kidneys could focus on improving utilisation of higher KDPI kidneys and perfusion techniques.
Presentation Slides PDF – Click here
Biography:
Rachel is a Research Officer at the Sydney School of Public Health, University of Sydney and a Registered Nurse. Her primary role at The University of Sydney is to assist academics with research projects, focussing on improving efficiency, quality and safety in organ procurement and access and equity to health services for those with kidney failure.