December 11, 2018
To help decrease national wait times for kidney transplantation, Johns Hopkins transplant surgeons have increased their use of so-called extended criteria kidneys from older or hepatitis-infected donors and donors after cardiac death—organs that some centers would define as “suboptimal.” Transplant surgeon Jacqueline Garonzik Wang hopes to increase other surgeons’ comfort in accepting these organs, which could result in the removal of thousands of people each year from the national kidney transplant waitlist.
Despite the positive outcomes of transplanting suboptimal kidneys, utilization rates vary widely among transplant centers nationwide. From 2000 to 2013, about 31,000 procured kidneys were discarded, says Garonzik Wang. This could be because regional centers were uncomfortable with the organs and passed on them, at which point it was too late to ship them to another center, she says.
Award Granted to Develop Report Cards for Transplant Centers
With a K23 grant from the National Institute of Diabetes and Digestive and Kidney Diseases, Garonzik Wang and research mentor Dorry Segev are developing report cards for each transplant center showing their aggressiveness in using suboptimal kidneys. The idea is that when surgeons are offered a suboptimal kidney from their local organ procurement organization, information about the organ would be paired with data from the Scientific Registry of Transplant Recipients. The data would show outcomes associated with transplants utilizing organs of similar quality in hopes that the information could help change organ selection behavior and increase the use of suboptimal kidneys.
“I would love to inspire people and get these organs utilized across the country equally,” says Garonzik Wang, “But if we can’t, then these organs should be preferentially allocated to surgeons willing to use them.”
Previous Research Revealed Limited Use of Suboptimal Kidneys
The work builds upon an earlier study of transplant center assertiveness led by Garonzik Wang published in the American Journal of Transplantation in 2012. She found only a small number of centers were aggressive in using suboptimal livers and kidneys. About 30 centers were not aggressive at all, and others were aggressive only with certain subtypes of organs. The centers more likely to use suboptimal organs tended to be located in densely populated areas with significant competition from other centers.
Soon after presenting her data at a 2013 transplant conference, “I got numerous emails from people asking me to send them a map showing transplant center aggressiveness so they could see where they were,” Garonzik Wang says. “There was this immediate interest for knowing exactly where their transplant centers stood.”
Despite interest in knowing the status of these centers, research indicates overall aggressiveness hasn’t increased since 2009. “I think it echoes that we need to do more to get this information out in a fashion that is digestible and applicable to transplant surgeons,” says Garonzik Wang.
To discuss a patient case or to make a referral to the Johns Hopkins transplant surgery team, please call 410-502-6152 or download the Johns Hopkins Transplant Center app for health care providers.
