{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:44:38Z","timestamp":1786373078116,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n We used national data to examine the outcomes of kidney transplant allocated as out of sequence offers to transplant centers in the United States.<\/jats:p>\n <\/jats:list-item>\n \n Short-term kidney graft failure does not differ between kidneys that were allocated as out of sequence offers versus standard allocation.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Changes in kidney allocation policies and regulations of Organ Procurement Organizations have affected the volume of organ offers and challenged transplant providers. One consequence is increased kidneys allocated out of sequence (OOS).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective observational study using Scientific Registry of Transplant Recipient data from 2021 to 2023, we analyzed donor and recipient characteristics for OOS versus standard kidney allocation and multivariable Cox models to evaluate graft survival. We also compared paired donors (one kidney OOS and the other standard allocation).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Annual OOS kidney allocation rates increased from 5.4% in 2021 to 18.4% in 2023. High OOS-use centers increased from 5 (2.2%) between 2021 and June 2022 to 37 (17%) in 2023. Listing at a high-OOS usage center was associated with increased rate of deceased donor transplantation (adjusted hazard ratio [AHR], 3.07; 95% confidence interval [CI], 2.90 to 3.25). Recipients of OOS allocation were more likely to be male (66% versus 59%), White race (38% versus 32%), privately insured (29% versus 24%), and preemptively transplanted (18% versus 10%). Overall graft loss was not significantly different between OOS and standard allocated transplants (AHR, 0.94; 95% CI, 0.85 to 1.05), consistent in paired donor analysis (AHR, 1.10; 95% CI, 0.86 to 1.41).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Short-term kidney graft failure does not differ between OOS and standard allocation. High-OOS kidney centers have higher deceased donor transplant rates. Further investigation is needed to understand demographic differences and factors explaining OOS allocation.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000945","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T17:01:50Z","timestamp":1764954110000},"page":"641-649","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Deceased Donor Kidney Transplants Allocated Out of Sequence in the United States"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-0785","authenticated-orcid":false,"given":"Anne M.","family":"Huml","sequence":"first","affiliation":[{"name":"Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-9288","authenticated-orcid":false,"given":"Joshua J.","family":"Augustine","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio D.","family":"Poggio","sequence":"additional","affiliation":[{"name":"Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-9481","authenticated-orcid":false,"given":"Alvin","family":"Wee","sequence":"additional","affiliation":[{"name":"Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-3932","authenticated-orcid":false,"given":"Susana","family":"Arrigain","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"},{"name":"Division of Education, Division of Transplant Surgery, Department of Surgery, Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4319-420X","authenticated-orcid":false,"given":"Rocio","family":"Lopez","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"},{"name":"Division of Education, Division of Transplant Surgery, Department of Surgery, Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5341-7286","authenticated-orcid":false,"given":"Jesse D.","family":"Schold","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado"},{"name":"Division of Education, Division of Transplant Surgery, Department of Surgery, Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Aurora, Colorado"},{"name":"Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"8","key":"B2-20260417","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-based kidney allocation","volume":"23","author":"Cron","year":"2023","journal-title":"Am J Transplant."},{"issue":"4","key":"B3-20260417","doi-asserted-by":"crossref","first-page":"e14925","DOI":"10.1111\/ctr.14925","article-title":"Current landscape of kidney allocation: Organ Procurement Organization perspectives","volume":"37","author":"Concepcion","year":"2023","journal-title":"Clin Transplant."},{"issue":"2","key":"B4-20260417","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ajt.2024.08.016","article-title":"Contemporary prevalence and practice patterns of out-of-sequence kidney allocation","volume":"25","author":"Liyanage","year":"2025","journal-title":"Am J Transplant."},{"issue":"5","key":"B5-20260417","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1111\/ajt.16951","article-title":"Deceased donor kidneys allocated out of sequence by Organ Procurement Organizations","volume":"22","author":"King","year":"2022","journal-title":"Am J Transplant."},{"issue":"6","key":"B6-20260417","doi-asserted-by":"crossref","first-page":"e2316936","DOI":"10.1001\/jamanetworkopen.2023.16936","article-title":"Characterization of transplant center decisions to allocate kidneys to candidates with lower waiting list priority","volume":"6","author":"King","year":"2023","journal-title":"JAMA Netw Open."},{"issue":"11","key":"B7-20260417","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.34067\/KID.0004052021","article-title":"Declined offers for deceased donor kidneys are not an independent reflection of organ quality","volume":"2","author":"King","year":"2021","journal-title":"Kidney360."},{"issue":"8","key":"B8-20260417","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.ajt.2025.04.002","article-title":"Underrecognition of deceased-donor kidney out-of-sequence allocation due to increasing use of free text coding","volume":"25","author":"Tucker","year":"2025","journal-title":"Am J Transplant."},{"issue":"19","key":"B9-20260417","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New Creatinine- and cystatin C\u2013Based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"New Engl J Med."},{"issue":"11","key":"B10-20260417","doi-asserted-by":"crossref","first-page":"e15094","DOI":"10.1111\/ctr.15094","article-title":"Outcomes with transplanting kidneys offered through expedited allocation","volume":"37","author":"Jadlowiec","year":"2023","journal-title":"Clin Transplant."},{"issue":"2S1","key":"B12-20260417","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1016\/j.ajt.2024.01.012","article-title":"OPTN\/SRTR 2022 annual data report: Kidney","volume":"24","author":"Lentine","year":"2024","journal-title":"Am J Transplant."},{"issue":"4","key":"B13-20260417","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.ekir.2025.01.021","article-title":"Outcomes for patients with a deceased donor kidney offer in the new allocation system","volume":"10","author":"Mohan","year":"2025","journal-title":"Kidney Int Rep."},{"issue":"12","key":"B14-20260417","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.1681\/ASN.2020030335","article-title":"Major variation across local transplant centers in probability of kidney transplant for wait-listed patients","volume":"31","author":"King","year":"2020","journal-title":"J Am Soc Nephrol."},{"issue":"1","key":"B16-20260417","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/ajt.16866","article-title":"Accelerating deceased donor kidney utilization requires more than accelerating placement","volume":"22","author":"Mohan","year":"2022","journal-title":"Am J Transplant."},{"issue":"2","key":"B17-20260417","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.ajt.2024.09.022","article-title":"Out-of-sequence allocation: a necessary innovation or a new inequity in transplantation?","volume":"25","author":"Adler","year":"2025","journal-title":"Am J Transplant."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:42:02Z","timestamp":1786369322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000945","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"assertion":[{"value":"2025-07-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}