- www.transplantjournal.com tality and graft loss with high KDPI kidneys compared to non-preferred to non-preferred tality and graft loss with high KDPI kidneys compared with high KDPI kidneys can be The risks of recipients. selection. recipient appropriate but not eliminated, by decreased, (Massie), K24DK101828 NIH F32DK113719 (Jackson), K01DK101677 Doris Duke Charitable (Segev), and K23DK115908 (Garonzik-Wang). (Garonzik-Wang). Foundation Clinician Scientist Development Program 306.4 using high Kidney of kidney transplantation risks Decreasing study. kidneys: A national cohort Index Donor Profile Allan Massie, Jennifer Motter, Kyle Jackson, Dorry L Segev Jacqueline Garonzik-Wang, MD, United States. Johns Hopkins Hospital, Baltimore, Surgery, score Index (KDPI) is a numerical The Kidney Donor Profile Background: with higher scores donor kidney quality, relative that represents 0-100% from often a high KDPI (≥ 85%) are with lower quality organs. Kidneys representing loss. graft and mortality post-transplant of risk increased an to due discarded KPDI tolerate high might recipients hypothesized that some we However, these grafts. receive best suited to therefore kidneys well, and are SRTR between 2006-2017, we data from Methods: Using national registry (≥ 85%) kidneys of high KDPI 10,361 kidney transplant recipients compared recipient identified of low KDPI (< 85%) kidneys. We to 120,983 recipients and attenuated) the impact of high KDPI on mortality factors that amplified (or without amplifying analysis, classifying recipients graft loss using interaction compared We recipients. factors and with attenuating factors as preferred KDPI kidneys in preferred mortality and graft loss with high KDPI versus low using Cox regression. recipients and non-preferred determined to be of high KDPI kidneys were recipients Results: Preferred ≥ hours of cold ischemic time, who were of a kidney with ≥ 24 recipients diabetes as the cause of 60 years old, non-white, with diabetes or who had of their ESRD. Preferred their ESRD, and without cystic disease as the cause ratio [HR]: 0.520.610.72, mortality risk (hazard had a 39% reduced recipients This recipients. to non-preferred p<0.001) with high KDPI kidneys compared risk (HR: 1.061.231.43, p=0.008) mortality translated to a 23% increased in recipients, in preferred with a high KDPI kidney versus a low KDPI kidney mortality risk (HR: 1.902.002.11, p<0.001) comparison to a 100% increased had a 28% recipients preferred Similarly, (Figure). recipients for non-preferred p<0.001) with a high KDPI risk of graft loss (HR: 0.610.720.85, reduced This translated to a 43% recipients. to non-preferred kidney compared 1.211.431.70, p<0.001) with a high KDPI risk of graft loss (HR: increased in comparison to a recipients, kidney versus a low KDPI kidney in preferred - (HR: 1.881.962.04, p<0.001) for non-pre risk of graft loss 96% increased (Figure). recipients ferred reduced risk of mor had a significantly recipients Conclusions: Preferred

1 Number 11S Number ■ 1 Gokhan Moray, 1 Nevzat Bilgin 2 November 2019 Volume 103 103 Volume 2019 November ■

Ebru H Ayvazoglu Soy, Ebru H Ayvazoglu 1 Gulnaz Arslan, 2 Transplantation S60 Anesthesiology and Reanimation, Faculty of Medicine, Baskent Anesthesiology and Reanimation, General Surgery, Division of Transplantation, Faculty of Medicine, Division of Transplantation, General Surgery, University, , . University, Baskent University, Ankara, Turkey. Ankara, Turkey. Baskent University, 1 Adnan Torgay, became the preferred procedure for treatment of end treatment for procedure the preferred Organ transplantation became of any transplantation organization depends The success stage organ failure. social, psychological, economical and religious on legal, ethical, medical, issues; these to regard with created should be system effective factors. An to legislation is lacking then it is better especially legislation. If transplantation in this country. stop or abandon transplantation our in Turkey, deceased-donor donation program In an attempt to start a and worked in cooperation with international contacted networks, group Foundation (Richmond, including the South Eastern Organ Procurement Foundation (Leiden, The Netherlands). USA) and the Eurotransplant VA, first deceased-donor kidney transplanta- able to perform the Thus, we were by the Eurotransplant tion on October 10, 1978, using an organ supplied Foundation. of legislation in governDuring the early periods of transplantation, the lack - - this prob overcome To in Turkey. ing organ donation was the main hurdle of the Parliament, officials lem, we made attempts to convince members of the Ministry of Health that transplantation and Department of Religious Affairs suc- were efforts Our supported. be should and procedure saving life a was and preservation on organ procurement, a law cessful and we structured many countries. On June transplantation, which was used as a model by Government, and later that month 3,1979 the law was enacted by Turkish kidney transplanta- on June 27, we performed the first local deceased-donor education about the ben- public to provide worked with the Turkish tion. We involved in organ donation. In addition, we responsibilities efits of and social Foundation and Burn Treatment Organ Transplantation founded The Turkish On January 21,1982 organ donation cards. in 1980 and printed standardized 2594, enacted Law the 2238, with to Law added were additional articles next-of-kin. In from consent without donation allowed for deceased which Center as Coordination 2001, the Ministry of Health established the National transplantation activities, especially for organization to promote an umbrella deceased organ This system increased deceased donor organ procurement. 0.9 pmp to 7 pmp in 18 years. from procurement we have performed 3007 kidney and since 1988, 629 liver trans- Until now, Turkey, history in organ transplantation solid of 40 years over plants. In living); 14185 livers (4187 38477 kidney transplants (8278 deceased, 30199 have transplants 195 pancreas and hearts; deceased, 9998 living); 1048 centers. been performed nationwide in 82 different the country, accelerating day by day throughout activities are Transplantation to increase rates. Efforts still far below the desired but deceased donors are and pri- the media, schools, and many public continue through awareness are in legislation, education and coordination vate institutions. Improvements the quality and the quantity of transplantation activi- key factors for increasing ties in Turkey. 2 Mehmet Haberal, Transplantation legislations in Turkey. Transplantation 306.3

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