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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait-listing status
Clinical transplantation, v 32(10), pp e13386-n/a
01 Oct 2018
PMID: 30132986
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
It is unknown whether the new kidney transplant allocation system (KAS) has attenuated the advantages of preemptive wait-listing as a strategy to minimize pretransplant dialysis exposure.
MethodsResultsWe performed a retrospective study of adult US deceased donor kidney transplant (DDKT) recipients between December 4, 2011-December 3, 2014 (pre-KAS) and December 4, 2014-December 3, 2017 (post-KAS). We estimated pretransplant dialysis durations by preemptive listing status in the pre- and post-KAS periods using multivariable gamma regression models.
Among 65385 DDKT recipients, preemptively listed recipients (21%, n=13696) were more likely to be white (59% vs 34%, P<0.001) and have private insurance (64% vs 30%, P<0.001). In the pre- and post-KAS periods, average adjusted pretransplant dialysis durations for preemptively listed recipients were <2years in all racial groups. Compared to recipients who were listed after starting dialysis, preemptively listed recipients experienced 3.85 (95% Confidence Interval [CI] 3.71-3.99) and 4.53 (95% CI 4.32-4.74) fewer average years of pretransplant dialysis in the pre- and post-KAS periods, respectively (P<0.001 for all comparisons).
ConclusionsPreemptively wait-listed DDKT recipients continue to experience substantially fewer years of pretransplant dialysis than recipients listed after dialysis onset. Efforts are needed to improve both socioeconomic and racial disparities in preemptive wait-listing.
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Details
- Title
- Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait-listing status
- Creators
- Meera N. Harhay - Drexel UniversityMichael O. Harhay - University of PennsylvaniaKarthik Ranganna - Drexel UniversitySuzanne M. Boyle - Drexel UniversityLissa Levin Mizrahi - Drexel UniversityStephen Guy - Drexel UniversityGregory E. Malat - Drexel UniversityGary Xiao - Drexel UniversityDavid J. Reich - Drexel UniversityRachel E. Patzer - Emory University
- Publication Details
- Clinical transplantation, v 32(10), pp e13386-n/a
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- 234-2005-37011C / Health Resources and Services Administration; United States Department of Health & Human Services; United States Health Resources & Service Administration (HRSA) K23DK105207 / National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) K99HL141678 / National Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); College of Medicine; Surgery
- Web of Science ID
- WOS:000447379000008
- Scopus ID
- 2-s2.0-85053437561
- Other Identifier
- 991019168881704721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery
- Transplantation