{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:58:55Z","timestamp":1790085535982,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Allocation out of sequence (AOOS) of kidneys has increased after KAS250 and raised concerns regarding transparency and equitable recipient selection. Less is known about recipient selection and outcomes at individual centers.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed a single\u2010center retrospective study of adult deceased donor kidney transplants at the University of Wisconsin from March 15, 2021, to March 31, 2024. Recipients receiving kidneys classified as AOOS were compared with contemporaneous recipients of non\u2010AOOS kidneys. Donor and recipient characteristics, delayed graft function, graft function, and patient and graft survival were assessed. Standardized data explaining why kidneys entered AOOS allocation were unavailable.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 498 deceased donor kidney transplant recipients, 89 (17.9%) received AOOS classified kidneys. Donor characteristics were largely similar, although kidneys categorized as AOOS had higher terminal creatinine (1.6\u00a0vs. 1.2\u00a0mg\/dl,\n p<\/jats:italic>\n \u00a0=\u00a00.03) and longer cold ischemia time (22.9\u00a0vs. 20.4\u00a0h,\n p<\/jats:italic>\n \u00a0=\u00a00.003). AOOS recipients were older, more often preemptive, had shorter waiting times, and were less likely to be retransplant recipients or have cPRA >\u00a020%. Recipient sex and race did not differ. Four\u2010year adjusted patient survival (aHR 0.85; 95% CI 0.38\u20131.94;\n p<\/jats:italic>\n \u00a0=\u00a00.71) and graft survival (aHR 0.72; 95% CI 0.34\u20131.54;\n p<\/jats:italic>\n \u00a0=\u00a00.40) were not statistically different.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this single\u2010center experience, transplantation of kidneys categorized as AOOS was associated with distinct recipient selection, comparable 4\u2010year outcomes, and without compromising gender\/racial balance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ctr.70647","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:42:21Z","timestamp":1786635741000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Recipient Selection and Outcomes After Out\u2010of\u2010Sequence Kidney Allocation Since Implementation of Kidney Allocation System 250 (KAS250): A Single\u2010Center Experience"],"prefix":"10.1111","volume":"40","author":[{"given":"Sandesh","family":"Parajuli","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen E.","family":"Leverson","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Mandelbrot","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dixon B.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin 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Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70647","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70647","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70647","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:31:31Z","timestamp":1787679091000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/ctr.70647"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70647","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-06-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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