{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:41Z","timestamp":1786480301516,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2-TR001874"],"award-info":[{"award-number":["KL2-TR001874"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01-DK114893-01"],"award-info":[{"award-number":["R01-DK114893-01"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01-DK116066-01"],"award-info":[{"award-number":["U01-DK116066-01"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute of Minority Health and Health Disparities","doi-asserted-by":"crossref","award":["R01-MD014161"],"award-info":[{"award-number":["R01-MD014161"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>13% of deceased donor kidneys are declined \u2265100 times before transplantation, with 3% accumulating &gt;1000 declined offers<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Hard-to-place kidneys have more frequent delayed graft function, but similar long-term adjusted graft and patient survival outcomes<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Frequently declined kidneys may represent missed opportunities for earlier successful transplant for the patients who are passed over<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Deceased donor kidney offers are frequently declined multiple times before acceptance for transplantation, despite significant organ shortage and long waiting times. Whether the number of times a kidney has been declined, reflecting cumulative judgments of clinicians, is associated with long-term transplant outcomes remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this national, retrospective cohort study of deceased donor kidney transplants in the United States from 2008 to 2015 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =78,940), we compared donor and recipient characteristics and short- and long-term graft and patient survival outcomes grouping by the sequence number at which the kidney was accepted for transplantation. We compared outcomes for kidneys accepted within the first seven offers in the match-run, after 8\u2013100 offers, and for hard-to-place kidneys distinguishing those requiring &gt;100 and &gt;1000 offers before acceptance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Harder-to-place kidneys had lower donor quality and higher rates of delayed graft function (46% among kidneys requiring &gt;1000 offers before acceptance versus 23% among kidneys with \u22647 offers). In unadjusted models, later sequence groups had higher hazard of all-cause graft failure, death-censored graft failure, and patient mortality; however, these associations were attenuated after adjusting for Kidney Donor Risk Index (KDRI). After adjusting for donor factors already taken into consideration during allocation, and recipient factors associated with long-term outcomes, graft, and patient survival outcomes were not significantly different for the hardest-to-place kidneys compared with the easiest-to-place kidneys, with the exception of death-censored graft failure (adjusted hazard ratio, 1.16, 95% CI, 1.05 to 1.28).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Late sequence offers may represent missed opportunities for earlier successful transplant for the higher-priority waitlisted candidates for whom the offers were declined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0004052021","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T16:50:14Z","timestamp":1629823814000},"page":"1807-1818","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Declined Offers for Deceased Donor Kidneys Are Not an Independent Reflection of Organ Quality"],"prefix":"10.34067","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-7615","authenticated-orcid":false,"given":"Kristen L.","family":"King","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York, New York"},{"name":"The Columbia University Renal Epidemiology Group, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulemon G.","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd E.","family":"Ratner","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-0117","authenticated-orcid":false,"given":"S. Ali","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York, New York"},{"name":"The Columbia University Renal Epidemiology Group, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-9685","authenticated-orcid":false,"given":"Sumit","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York, New York"},{"name":"The Columbia University Renal Epidemiology Group, New York, New York"},{"name":"Department of Epidemiology, Mailman School of Public Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11,25]]},"reference":[{"key":"B2-20250825","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.kint.2018.02.016","article-title":"Factors leading to the discard of 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UK","volume":"28","author":"Callaghan","year":"2014","journal-title":"Clin Transplant"},{"key":"B13-20250825","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jamainternmed.2019.2322","article-title":"Disparities in acceptance of deceased donor kidneys between the United States and France and estimated effects of increased US acceptance","volume":"179","author":"Aubert","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"Suppl 2","key":"B14-20250825","first-page":"521","article-title":"OPTN\/SRTR 2019 Annual Data Report: Deceased organ donors","volume":"21","author":"Israni","year":"2021","journal-title":"Am J Transplant"},{"issue":"Suppl 1","key":"B15-20250825","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/ajt.14131","article-title":"OPTN\/SRTR 2015 Annual Data Report: Deceased organ donation","volume":"17","author":"Israni","year":"2017","journal-title":"Am J Transplant"},{"issue":"Suppl 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