Kidney Discard Rates in the United States During American Transplant Congress Meetings.

BACKGROUND: Deceased-donor kidney discard rates vary by region, but it is unknown whether discard rates and transplant outcomes vary during the American Transplant Congress (ATC) each year. METHODS: Using national registry data, we determined rates of kidney discard, delayed graft function, graft failure, and mortality from December 31, 1999, through December 30, 2015, during ATC dates and compared these rates with those on the same days of the week during the 2 weeks before and after the ATC (non-ATC). We used multivariable regression to determine associations between ATC and these outcomes. RESULTS: From 7902 donors (1575 ATC; 6327 non-ATC), 12 588 recipients received kidney transplants (2455 ATC; 10 133 non-ATC), and 2666 kidneys were discarded (582 ATC; 2084 non-ATC). Kidneys were more often discarded during ATC (19% vs 17%, P = 0.006; adjusted odds ratio, 1.21; 95% confidence interval, 1.05-1.40). There were no significant differences in donor, transplant, or recipient characteristics by ATC/non-ATC dates or by ATC/non-ATC transplant dates for delayed graft function, graft failure, or mortality. CONCLUSIONS: On the basis of a 21% increased odds of discard, the ATC itself may result in 5 additional kidney discards during this important conference every year, which suggests the need for innovative staffing or other logistic solutions during these planned meetings.

Early Conversion to Belatacept in Kidney Transplant Recipients With Low Glomerular Filtration Rate.

BACKGROUND: Our aim was to determine the impact of converting from tacrolimus to belatacept in patients with stable low estimated glomerular filtration rate (eGFR) early after kidney transplant. METHODS: This is a single-center retrospective case control study. During this study period, we had a clinical protocol to convert patients to belatacept if they had a stable but low GFR and they were at least 1-month posttransplant. Eligible patients had stable but low eGFR usually < 40 mL/min per 1.73 m. We used direct matching to select 1 control case for each patient converted to belatacept. The primary outcome was the change in eGFR from the point of belatacept conversion to 4 months postconversion (delta eGFR). RESULTS: There were 30 patients in the conversion group and 30 in a direct matched control group. The median preconversion eGFR for the entire cohort was 23.0 mL/min per 1.73 m with an interquartile range of 15.7 to 31.4. The delta eGFR was 11.0 (12.9) mL/min per 1.73 m in belatacept group and 4.8 (10.5) mL/min per 1.73 m in the control group (P = 0.045). Acute rejection postconversion occurred in 5 (16.7%) in the conversion group and none of the control group (P = 0.052). Although the delta improvement in eGFR was about 6 mL/min better in the Belatacept group, there was no difference in the slope of inverse creatinine during the 12-month period after conversion between the groups. CONCLUSIONS: We conclude that early belatacept conversion in kidney transplant recipients with stable low eGFR may only result in a modest increase in GFR.