Steven Habbous1, Jennifer Arnold2, Mehmet A Begen3, Neil Boudville4, Matthew Cooper5, Christine Dipchand6, Stephanie N Dixon7, Liane S Feldman8, Dariusz Goździk2, Martin Karpinski9, Scott Klarenbach10, Greg A Knoll11, Ngan N Lam10, Krista L Lentine12, Charmaine Lok13, Eric McArthur8, Susan McKenzie14, Matthew Miller15, Mauricio Monroy-Cuadros16, Chris Nguan17, G V Ramesh Prasad18, Sebastian Przech1, Sisira Sarma1, Dorry L Segev19, Leroy Storsley9, Amit X Garg20. 1. Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada. 2. London Health Sciences Centre, London, Ontario, Canada. 3. Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Ivey School of Business, Western University, London, Ontario, Canada. 4. University of Western Australia, Nedlands, WA, Australia. 5. MedStar Georgetown Transplant Institute, Washington, DC. 6. Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia. 7. Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada. 8. McGill University Health Centre, Montreal, Quebec, Canada. 9. Winnipeg Health Sciences Centre, Winnipeg, Manitoba, Canada. 10. University of Alberta, Edmonton, Alberta, Canada. 11. Ottawa General Hospital, Ottawa, Ontario, Canada. 12. Centre for Abdominal Transplantation, St. Louis University School of Medicine, St. Louis, MO. 13. University Health Network, Toronto. 14. Kidney Foundation of Canada. 15. St Joseph's Healthcare, Hamilton, Ontario, Canada. 16. Foothills Medical Centre, Calgary, Alberta, Canada. 17. Vancouver General Hospital, Vancouver, British Columbia, Canada. 18. St. Michael's Hospital, Toronto, Ontario, Canada. 19. Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 20. Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada. Electronic address: amit.garg@lhsc.on.ca.
Abstract
BACKGROUND: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. STUDY DESIGN: 1 prospective and 1 retrospective cohort study. SETTING & PARTICIPANTS: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times. Data were obtained from 2 sources: donor medical records using chart abstraction and health care administrative databases. PREDICTORS: Donor and recipient demographics, direct versus paired donation, center-level variables. OUTCOMES: Duration of living donor evaluation. RESULTS: The median total duration of transplantation evaluation (time from when the candidate started the evaluation until donation) was 10.3 (IQR, 6.5-16.7) months. The median duration from evaluation start until approval to donate was 7.9 (IQR, 4.6-14.1) months, and from approval until donation was 0.7 (IQR, 0.3-2.4) months, respectively. The median time between the first and last consultation among donors who completed a nephrology, surgery, and psychosocial assessment in the prospective cohort was 3.0 (IQR, 1.0-6.3) months, and between computed tomography angiography and donation was 4.8 (IQR, 2.6-9.2) months. After adjustment, the total duration of transplantation evaluation was longer if the donor participated in paired donation (6.6 [95% CI, 1.6-9.7] months) and if the recipient was referred later relative to the donor's evaluation start date (0.9 [95% CI, 0.8-1.0] months [per month of delayed referral]). Results depended on whether the recipient was receiving dialysis. LIMITATIONS: Living donor candidates who did not donate were not included and proxy measures were used for some dates in the donor evaluation process. CONCLUSIONS: The duration of kidney transplant donor evaluation is variable and can be lengthy. Better understanding of the reasons for a prolonged evaluation may inform quality improvement initiatives to reduce unnecessary delays.
BACKGROUND: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. STUDY DESIGN: 1 prospective and 1 retrospective cohort study. SETTING & PARTICIPANTS: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times. Data were obtained from 2 sources: donor medical records using chart abstraction and health care administrative databases. PREDICTORS: Donor and recipient demographics, direct versus paired donation, center-level variables. OUTCOMES: Duration of living donor evaluation. RESULTS: The median total duration of transplantation evaluation (time from when the candidate started the evaluation until donation) was 10.3 (IQR, 6.5-16.7) months. The median duration from evaluation start until approval to donate was 7.9 (IQR, 4.6-14.1) months, and from approval until donation was 0.7 (IQR, 0.3-2.4) months, respectively. The median time between the first and last consultation among donors who completed a nephrology, surgery, and psychosocial assessment in the prospective cohort was 3.0 (IQR, 1.0-6.3) months, and between computed tomography angiography and donation was 4.8 (IQR, 2.6-9.2) months. After adjustment, the total duration of transplantation evaluation was longer if the donor participated in paired donation (6.6 [95% CI, 1.6-9.7] months) and if the recipient was referred later relative to the donor's evaluation start date (0.9 [95% CI, 0.8-1.0] months [per month of delayed referral]). Results depended on whether the recipient was receiving dialysis. LIMITATIONS: Living donor candidates who did not donate were not included and proxy measures were used for some dates in the donor evaluation process. CONCLUSIONS: The duration of kidney transplant donor evaluation is variable and can be lengthy. Better understanding of the reasons for a prolonged evaluation may inform quality improvement initiatives to reduce unnecessary delays.
Authors: Steven Habbous; Eric McArthur; Stephanie N Dixon; Susan McKenzie; Carlos Garcia-Ochoa; Ngan N Lam; Krista L Lentine; Christine Dipchand; Kenneth Litchfield; Mehmet A Begen; Sisira Sarma; Amit X Garg Journal: Transplantation Date: 2018-07 Impact factor: 4.939
Authors: Steven Habbous; Lianne Barnieh; Kenneth Litchfield; Susan McKenzie; Marian Reich; Ngan N Lam; Istvan Mucsi; Ann Bugeja; Seychelle Yohanna; Rahul Mainra; Kate Chong; Daniel Fantus; G V Ramesh Prasad; Christine Dipchand; Jagbir Gill; Leah Getchell; Amit X Garg Journal: Clin J Am Soc Nephrol Date: 2020-09-24 Impact factor: 8.237
Authors: Steven Habbous; Justin Woo; Ngan N Lam; Krista L Lentine; Matthew Cooper; Marian Reich; Amit X Garg Journal: Transplant Direct Date: 2018-09-20
Authors: Ngan N Lam; Christine Dipchand; Marie-Chantal Fortin; Bethany J Foster; Anand Ghanekar; Isabelle Houde; Bryce Kiberd; Scott Klarenbach; Greg A Knoll; David Landsberg; Patrick P Luke; Rahul Mainra; Sunita K Singh; Leroy Storsley; Jagbir Gill Journal: Can J Kidney Health Dis Date: 2020-06-09