John Libbey Eurotext – Nephrology & Therapeutics

2023-05-31 20:19:24


1 Rennes University Hospital, Nephrology, Rennes, France
2 Biomedicine Agency, La Plaine Saint-Denis, France
3 University of Rennes, Rennes University Hospital, Inserm, EHESP, IRSET (Research Institute for Health, Environment and Work) – UMRS 1085, 35000 Rennes, France

Correspondence: B. Legendre


In a context of tension on the number of kidney grafts available compared to the number needed, the transplant refusal practices of the Rennes transplant center were evaluated.

Materials and methods

From the CRISTAL national register, donors completely refused by our team (no kidney accepted for any recipient from Rennes) between 1is January 2012 and December 31, 2015 were identified. The future of these rejected grafts (possible transplant in another center), the data of the recipients (Rennes and other centres) and the data of the donors (refused then finally accepted) were extracted.

The outcome of recipients (Rennes and other centres) was compared: survival of the graft (censored on death) and of the patient (uncensored on cessation of function). The KDPI score (Kidney Donor Profile Index) has been calculated and its interest studied.


Among the 203 refused donors, 172 (85%) allowed transplantation in another centre, 89% of which were functional grafts at one year. In univariate analysis, recipients from Rennes transplanted after refusal had better graft survival (censored on death) than recipients transplanted in another center with the graft refused (p < 0.001). The main limitation of this analysis is the non-comparability of the groups. The KDPI score was significantly associated with graft survival (censored on death).

Among the 151 patients from Rennes who were refused, 3% were still on the waiting list at the end of the observation period, the others spent an additional median time on dialysis of 220 days (Q1-Q3 81-483 ).


Rennais recipients transplanted after a first refusal seem to have better graft survival (censored on death) than recipients from other centers transplanted with rejected grafts. This is to be weighed against the additional time on dialysis, or even the risk of non-transplantation.

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