Outcomes with transplanting kidneys offered through expedited allocation

Introduction: Expedited out-of-sequence deceased donor kidney allocation is a strategy to avoid discards after early placement attempts have been unsuccessful. Our study aimed to assess outcomes and characteristics of these transplanted kidneys. Methods: KDPI matching was performed between expedited allocation (EA) and standard allocation (SA) deceased donor kidney transplants performed at our center. Results: Between 2018 and 2021, there were 225 EA offers, and 189 (84%) were transplanted. EA recipients were older (p =.007) and had shorter dialysis vintage (p <.0001). EA kidneys were likely to be nationally allocated (p <.001), have AKI (p <.0001) and longer CIT (p <.0001). There were no differences in EA and SA time-zero kidney biopsies (ci, p =.07; ct, p =.89; cv, p =.95; ah, p =.79). EA kidneys had more DGF (p =.0006), but there were no differences in DGF duration (p =.83), hospital length of stay (p =.43), 1- and 2-year eGFR (p =.16, p =.99), patient (p =.34), or death-censored graft (p =.66) survival. Conclusion: During this study period, our center transplanted 189 kidneys through EA following local-regional declines. These kidneys often came from AKI donors and had more DGF but had similar outcomes to KDPI-matched SA kidneys. Although it has been suggested that EA has the potential to worsen transplant disparities, transplant center level decisions on organ acceptance contribute to these variations.