{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:48:51Z","timestamp":1792586931969,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Transplant centers and organ procurement organizations (OPOs) collaborate to optimize organ use by facilitating out of sequence (OOS) kidney offers, but national data suggest this may worsen disparities. We retrospectively analyzed all kidney transplant recipients at a single center from July 2022 to July 2024. We compared OOS versus in\u2010sequence (IS) kidney transplants by demographics, panel reactive antibody scores (cPRA), socioeconomic factors, and dialysis vintage. Among 503 recipients, 330 (66%) received OOS kidneys. OOS recipients were older (61\u00a0vs. 57 years,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001), more frequently male (68%\u00a0vs. 55%,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.004), and had lower cPRA scores (17%\u00a0vs. 37%,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001). OOS recipients were more frequently white (61%\u00a0vs. 50%), had higher education and income levels, were more likely to have private insurance and be pre\u2010emptively transplanted. On multivariable analysis, longer dialysis duration (OR: 0.965 per month,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.0001) and higher cPRA (OR: 0.984 per percentage point,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.0001) were associated with lower odds of OOS transplant. Male gender was not associated with receipt of an OOS kidney (OR: 1.582,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.058). OOS kidneys were more frequently allocated to patients of higher socioeconomic status. These findings highlight the complexity of matching hard\u2010to\u2010place kidneys with medically appropriate recipients while maintaining equity across all factors.\n                  <\/jats:p>","DOI":"10.1111\/ctr.70718","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:31:16Z","timestamp":1792585876000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Equity in Kidney Allocation: An Examination of Out of Sequence Kidney Transplant Recipients at a Single Center"],"prefix":"10.1111","volume":"40","author":[{"given":"Christina","family":"Delvalle","sequence":"first","affiliation":[{"name":"Kidney Transplant Department Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Huml","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Isaacson","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Augustine","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhua","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Chia","family":"Lin","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Umair","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo Huidobro","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh","family":"Krishnamurthi","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin","family":"Wee","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Poggio","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eltemamy","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Department of Urology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ajt.2024.08.016","article-title":"Contemporary Prevalence and Practice Patterns of Out\u2010of\u2010Sequence Kidney Allocation","volume":"25","author":"Liyanage L. N.","year":"2025","journal-title":"American Journal of Transplantation"},{"issue":"2","key":"e_1_2_11_3_1","first-page":"456","article-title":"Deceased Donor Kidneys Allocated out of Sequence by Organ Procurement Organizations","volume":"22","author":"King K. L.","year":"2022","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16476"},{"issue":"8","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.ajt.2023.05.005","article-title":"Increased Volume of Organ Offers and Decreased Efficiency of Kidney Placement Under Circle\u2010Based Kidney Allocation","volume":"23","author":"Cron D. C.","year":"2023","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17002"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0191022"},{"issue":"9","key":"e_1_2_11_8_1","first-page":"3054","article-title":"The Role of Bypass Filters in Deceased Donor Kidney Allocation in the United States","volume":"21","author":"King K. L.","year":"2021","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15012"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2011.12.005"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000869"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.09.022"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.0000000000000449"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001883"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.0512"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14946"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.12611021"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2012.04089.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15290"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.0000001010"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.70574"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70718","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70718","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70718","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:31:17Z","timestamp":1792585877000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ctr.70718"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70718","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70718"}}