BACKGROUND: Despite providing survival benefit, increased risk for infectious disease (IRD) kidney offers are declined at 1.5 times the rate of non-IRD kidneys. Elucidating sources of variation in IRD kidney offer acceptance may highlight opportunities to expand use of these life-saving organs. METHODS: To explore center-level variation in offer acceptance, we studied 6765 transplanted IRD kidneys offered to 187 transplant centers between 2009 and 2017 using Scientific Registry of Transplant Recipients data. We used multilevel logistic regression to determine characteristics associated with offer acceptance and to calculate the median odds ratio (MOR) of acceptance (higher MOR indicates greater heterogeneity). RESULTS: Higher quality kidneys (per 10 units kidney donor profile index; adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.92-0.95), higher yearly volume (per 10 deceased donor kidney transplants; aOR, 1.08, 95% CI, 1.06-1.10), smaller waitlist size (per 100 candidates; aOR, 0.97; 95% CI, 0.95-0.98), and fewer transplant centers in the donor service area (per center; aOR, 0.88; 95% CI, 0.85-0.91) were associated with greater odds of IRD acceptance. Adjusting for donor and center characteristics, we found wide heterogeneity in IRD offer acceptance (MOR, 1.96). In other words, if listed at a center with more aggressive acceptance practices, a candidate could be 2 times more likely to have an IRD kidney offer accepted. CONCLUSIONS: Wide national variation in IRD kidney offer acceptance limits access to life-saving kidneys for many transplant candidates.
BACKGROUND: Despite providing survival benefit, increased risk for infectious disease (IRD) kidney offers are declined at 1.5 times the rate of non-IRD kidneys. Elucidating sources of variation in IRD kidney offer acceptance may highlight opportunities to expand use of these life-saving organs. METHODS: To explore center-level variation in offer acceptance, we studied 6765 transplanted IRD kidneys offered to 187 transplant centers between 2009 and 2017 using Scientific Registry of Transplant Recipients data. We used multilevel logistic regression to determine characteristics associated with offer acceptance and to calculate the median odds ratio (MOR) of acceptance (higher MOR indicates greater heterogeneity). RESULTS: Higher quality kidneys (per 10 units kidney donor profile index; adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.92-0.95), higher yearly volume (per 10 deceased donor kidney transplants; aOR, 1.08, 95% CI, 1.06-1.10), smaller waitlist size (per 100 candidates; aOR, 0.97; 95% CI, 0.95-0.98), and fewer transplant centers in the donor service area (per center; aOR, 0.88; 95% CI, 0.85-0.91) were associated with greater odds of IRD acceptance. Adjusting for donor and center characteristics, we found wide heterogeneity in IRD offer acceptance (MOR, 1.96). In other words, if listed at a center with more aggressive acceptance practices, a candidate could be 2 times more likely to have an IRD kidney offer accepted. CONCLUSIONS: Wide national variation in IRD kidney offer acceptance limits access to life-saving kidneys for many transplant candidates.
Authors: L M Kucirka; H Sarathy; P Govindan; J H Wolf; T A Ellison; L J Hart; R A Montgomery; R L Ros; D L Segev Journal: Am J Transplant Date: 2011-03-02 Impact factor: 8.086
Authors: Peter P Reese; Tara Tehrani; Mary Ann Lim; David A Asch; Emily A Blumberg; Maureen K Simon; Roy D Bloom; Scott D Halpern Journal: Clin J Am Soc Nephrol Date: 2010-03-25 Impact factor: 8.237
Authors: R Lorie Ros; Lauren M Kucirka; Priyanka Govindan; Harini Sarathy; Robert A Montgomery; Dorry L Segev Journal: Clin Transplant Date: 2011-05-09 Impact factor: 2.863
Authors: L M Kucirka; H Sarathy; P Govindan; J H Wolf; T A Ellison; L J Hart; R A Montgomery; R L Ros; D L Segev Journal: Am J Transplant Date: 2011-03-14 Impact factor: 8.086
Authors: Peter P Reese; Scott D Halpern; David A Asch; Roy Bloom; Howard Nathan; Richard Hasz; Joseph Roth; William Reitsma; Louis Krefski; Fred Goerlitz; Gina DeLauro; Emily Blumberg; Francis L Weng; Arthur Caplan; Arwin Thomasson; Justine Shults; Harold I Feldman Journal: Transplantation Date: 2011-06-15 Impact factor: 4.939
Authors: P P Reese; H I Feldman; D A Asch; S D Halpern; E A Blumberg; A Thomasson; J Shults; R D Bloom Journal: Am J Transplant Date: 2009-08-21 Impact factor: 8.086
Authors: Darren Lee; Indra Gramnea; Nina Seng; Meaghan Bruns; Fiona Hudson; Rohit D'Costa; Leanne McEvoy; Joe Sasadeusz; Michael J O'Leary; Gopal Basu; Joshua Y Kausman; Rosemary Masterson; Kathy Paizis; John Kanellis; Peter D Hughes; David J Goodman; John B Whitlam Journal: Transplant Direct Date: 2021-09-07