Factors Influencing Outcome After Deceased Heart Beating Donor Kidney Transplantation in the United Kingdom: An Evidence Base for a New National Kidney Allocation Policy

Johnson, Rachel J.1,6; Fuggle, Susan V.1,2; O'Neill, John1; Start, Samantha1; Bradley, J. Andrew3; Forsythe, John L. R.4; Rudge, Chris J.5; on behalf of the Kidney Advisory Group of NHS Blood and Transplant

Transplantation:
doi: 10.1097/TP.0b013e3181c90287
Editorials and Perspectives: Forum
Abstract

Background. Outcomes after deceased heart beating donor kidney transplantation are good, but survival rates vary according to a number of donor-, recipient-, and transplant-related factors. This comprehensive analysis of transplant outcomes was undertaken to inform development of a new Kidney Allocation Scheme.

Methods. A complete case analysis of the outcome of kidney-only transplants in the United Kingdom, 1995 to 2001, was undertaken using Cox regression modeling. Seven thousand three hundred eighty-five (77%) of the 9585 transplants reported to the UK Transplant Registry were primary transplants in adults. Regrafts and pediatric patients (age <18 years) were analyzed separately. Transplant and patient survival over 5 years were investigated in addition to causes of prolonged cold ischemia time (CIT).

Results. A variety of factors significantly adversely influenced kidney transplant and patient outcome, including older donor age, older recipient age, waiting time to transplant over 2 years, diabetes, and earlier year of transplant. Human leukocyte antigen mismatch and CIT were significant in analyses of transplant but not in patient outcome, and an increased graft failure rate was also identified in adolescent patients. CIT was prolonged by long-distance kidney exchanges between centers (2 hr) and reallocation of kidneys for alternative patients (7 hr).

Conclusion. This study identified a number of factors that influence transplant outcome after deceased heart beating donor kidney transplant in the United Kingdom. The findings suggest that the influences of human leukocyte antigen mismatch and CIT are most relevant in considering a revised kidney allocation scheme.

Author Information

1 National Health Service (NHS) Blood and Transplant, Bristol, United Kingdom.

2 Oxford Transplant Centre, Nuffield Department of Surgery, Churchill Hospital, Oxford, United Kingdom.

3 Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.

4 Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

5 Department of Health, Wellington House, London, United Kingdom.

6 Address correspondence to: Rachel Johnson, M.S.c., Organ Donation and Transplantation, NHS Blood and Transplant, Fox Den Road, Stoke Gifford, Bristol BS34 8RR, United Kingdom.

E-mail: rachel.johnson@nhsbt.nhs.uk

Received 8 October 2009. Revision requested 8 October 2009.

Accepted 15 October 2009.

© 2010 Lippincott Williams & Wilkins, Inc.