TY - JOUR
T1 - Geographic disparity in kidney transplantation under KAS
AU - Zhou, Sheng
AU - Massie, Allan B.
AU - Luo, Xun
AU - Ruck, Jessica M.
AU - Chow, Eric K.H.
AU - Bowring, Mary G.
AU - Bae, Sunjae
AU - Segev, Dorry L.
AU - Gentry, Sommer E.
N1 - Funding Information:
This work was supported by grant number 1R01DK111233-01 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
Publisher Copyright:
© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/6
Y1 - 2018/6
N2 - The Kidney Allocation System fundamentally altered kidney allocation, causing a substantial increase in regional and national sharing that we hypothesized might impact geographic disparities. We measured geographic disparity in deceased donor kidney transplant (DDKT) rate under KAS (6/1/2015-12/1/2016), and compared that with pre-KAS (6/1/2013-12/3/2014). We modeled DSA-level DDKT rates with multilevel Poisson regression, adjusting for allocation factors under KAS. Using the model we calculated a novel, improved metric of geographic disparity: the median incidence rate ratio (MIRR) of transplant rate, a measure of DSA-level variation that accounts for patient casemix and is robust to outlier values. Under KAS, MIRR was 1.751.811.86 for adults, meaning that similar candidates across different DSAs have a median 1.81-fold difference in DDKT rate. The impact of geography was greater than the impact of factors emphasized by KAS: having an EPTS score ≤20% was associated with a 1.40-fold increase (IRR = 1.351.401.45, P <.01) and a three-year dialysis vintage was associated with a 1.57-fold increase (IRR = 1.561.571.59, P <.001) in transplant rate. For pediatric candidates, MIRR was even more pronounced, at 1.661.922.27. There was no change in geographic disparities with KAS (P =.3). Despite extensive changes to kidney allocation under KAS, geography remains a primary determinant of access to DDKT.
AB - The Kidney Allocation System fundamentally altered kidney allocation, causing a substantial increase in regional and national sharing that we hypothesized might impact geographic disparities. We measured geographic disparity in deceased donor kidney transplant (DDKT) rate under KAS (6/1/2015-12/1/2016), and compared that with pre-KAS (6/1/2013-12/3/2014). We modeled DSA-level DDKT rates with multilevel Poisson regression, adjusting for allocation factors under KAS. Using the model we calculated a novel, improved metric of geographic disparity: the median incidence rate ratio (MIRR) of transplant rate, a measure of DSA-level variation that accounts for patient casemix and is robust to outlier values. Under KAS, MIRR was 1.751.811.86 for adults, meaning that similar candidates across different DSAs have a median 1.81-fold difference in DDKT rate. The impact of geography was greater than the impact of factors emphasized by KAS: having an EPTS score ≤20% was associated with a 1.40-fold increase (IRR = 1.351.401.45, P <.01) and a three-year dialysis vintage was associated with a 1.57-fold increase (IRR = 1.561.571.59, P <.001) in transplant rate. For pediatric candidates, MIRR was even more pronounced, at 1.661.922.27. There was no change in geographic disparities with KAS (P =.3). Despite extensive changes to kidney allocation under KAS, geography remains a primary determinant of access to DDKT.
KW - Organ Procurement and Transplantation Network (OPTN)
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - United Network for Organ Sharing (UNOS)
KW - kidney transplantation/nephrology
KW - organ allocation
KW - organ procurement and allocation
KW - organ procurement organization
KW - translational research/science
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U2 - 10.1111/ajt.14622
DO - 10.1111/ajt.14622
M3 - Article
C2 - 29232040
AN - SCOPUS:85041045635
SN - 1600-6135
VL - 18
SP - 1415
EP - 1423
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 6
ER -