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The following is a summary of “Being Waitlisted is not Enough—Identification of Pseudo-access to Kidney Transplantation in the United States,” published in the May 2025 issue of Annals of Surgery by Matevish et al.
Researchers conducted a retrospective study to examine how transplant center volume influenced access to kidney transplants among waitlisted candidates.
They gathered center-level data from all United States adult kidney transplant programs using the Scientific Registry of Transplant Recipients program-specific reports, with updates through [12/31/23]. A total of 196 programs were included. These programs were divided into quartiles based on annual deceased donor kidney transplant volume, with Q1 representing the lowest and Q4 representing the highest volume. Program-level acceptance behaviors and transplant outcomes were then compared across these quartiles.
The results showed that Q4 programs performed transplants in a greater proportion of their waitlisted individuals compared to Q1 programs (30.5% vs 13.1%; P<0.001). The transplant rate ratio was higher in Q4 (1.41 vs 0.74 for Q1; P<0.001), and the time to transplant was shorter (median time to transplant ratio: 0.79 vs 1.2 for Q1; P=0.008). Offer acceptance ratios were elevated in Q4, especially for marginal allografts with Kidney Donor Risk Index greater than 1.75 (1.51 vs 0.46 for Q1; P<0.001) and hard-to-place kidneys with more than 100 offers (1.18 vs 0.25 for Q1; P<0.001). Post-transplant hospital stays were shorter in Q4 (median 4 days [4–5] vs 6 [5–7] for Q1; P<0.001), despite greater use of marginal grafts.
Investigators concluded that high-volume (HV) programs achieved better transplant access through more aggressive organ use, while low-volume (LV) programs may require structural changes or consolidation to improve outcomes.
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