Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

Abstract

Introduction:

The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%.

Research Question:

We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist.

Design:

We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression.

Results:

Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated (r ² = 0.84).

Discussion:

Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

Keywords

geographic disparities deceased donor kidney organ allocation health policy

Get full access to this article

View all access options for this article.

References

Davis

Mehrotra

Kilambi

, et al. The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States. Clin J Am Soc Nephrol. 2014;9(8):1449–1460. doi:10.2215/CJN.05350513.

Davis

Mehrotra

McElroy

, et al. The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States. Transplantation. 2014;97(10):1049–1057. doi:10.1097/01.tp.0000438623.89310.dc.

Zhou

Massie

Luo

, et al. Geographic disparity in kidney transplantation under KAS. Am J Transplant. 2018;18(6):1415–1423. doi:10.1111/ajt.14622.

Mathur

Ashby

Sands

Wolfe

. Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation. Am J Transplant. 2010;10(4 Pt 2):1069–80. doi:10.1111/j.1600-6143.2010.03043.x.

Garonzik-Wang

James

Weatherspoon

, et al. The aggressive phenotype: center-level patterns in the utilization of suboptimal kidneys. Am J Transplant. 2012;12(2):400–408. doi:10.1111/j.1600-6143.2011.03789.x.

Merion

Ashby

Wolfe

, et al. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA. 2005;294(21):2726–2733.

Massie

Luo

Chow

Alejo

Desai

Segev

. Survival benefit of primary deceased donor transplantation with high-KDPI kidneys. Am J Transplant. 2014;14(10):2310–2316. doi:10.1111/ajt.12830.

Organ Procurement and Transplantation Network. Policies. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_08. Published 2019. Accessed July 31, 2019.

Organ Procurement and Transplantation Network. A guide to calculating and interpreting the Estimated Post-Transplant Survival (EPTS) score used in the Kidney Allocation System (KAS). https://optn.transplant.hrsa.gov/media/1511/guide_to_calculating_interpreting_epts.pdf. Published 2018. Accessed July 31, 2019.

10.

Organ Procurement and Transplantation Network. Guide to calculating and interpreting the Kidney Donor Profile Index (KDPI). https://optn.transplant.hrsa.gov/media/1512/guide_to_calculating_interpreting_kdpi.pdf. Published 2018. Accessed December 4, 2018.

11.

Organ Procurement and Transplantation Network. Policy 8: Allocation of Kidneys. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Published 2019. Accessed July 31, 2019.

12.

Wolfe

Ashby

Milford

, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–1730.

13.

Rabbat

Thorpe

Russell

Churchill

. Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol. 2000;11(5):917–922.

14.

Oniscu

Brown

Forsythe

. Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol. 2005;16(6):1859–1865.

15.

Organ Procurement and Transplantation Network—HRSA. Final rule with comment period. Fed Regist. 1998;63(63):16296–338.

16.

Stewart

Wilk

Toll

, et al. Measuring and monitoring equity in access to deceased donor kidney transplantation. Am J Transplant. 2018;18(8):1924–1935. doi:10.1111/ajt.14922.

17.

Goldberg

French

Abt

Gilroy

. Increasing the number of organ transplants in the united states by optimizing donor authorization rates. Am J Transplant. 2015;15(8):2117–2125. doi:10.1111/ajt.13362.

18.

Centers for Disease Control and Prevention. Mortality Tables. https://www.cdc.gov/nchs/data/dvs/mortfinal2007_worktable23r.pdf. Accessed July, 31 2019.

19.

Snyder

Salkowski

Wey

Pyke

Israni

Kasiske

. Organ distribution without geographic boundaries: a possible framework for organ allocation. Am J Transplant. 2018;18(11):2635–2640. doi:10.1111/ajt.15115.

20.

Miles

Westphal

Liapakis

Formica

. Simultaneous liver-kidney transplantation: impact on liver transplant patients and the kidney transplant waiting list. Curr Transplant Rep. 2018;5(1):1–6. doi:10.1007/s40472-018-0175-z.

21.

Reese

Veatch

Abt

Amaral

. Revisiting multi-organ transplantation in the setting of scarcity. Am J Transplant. 2014;14(1):21–6. doi:10.1111/ajt.12557.

22.

Hart

Gustafson

Skeans

, et al. OPTN/SRTR 2015 Annual data report: early effects of the new kidney allocation system. Am J Transplant. 2017;17(suppl 1):543–564. doi:10.1111/ajt.14132.

23.

Stewart

Kucheryavaya

Klassen

Turgeon

Formica

Aeder

. Changes in deceased donor kidney transplantation one year after KAS implementation. Am J Transplant. 2016;16(6):1834–1847. doi:10.1111/ajt.13770.

24.

Stewart

Garcia

Aeder

Klassen

. New insights into the alleged kidney donor profile index labeling effect on kidney utilization. Am J Transplant. 2017;17(10):2696–2704. doi:10.1111/ajt.14379.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB

0.53 MB