National Variation in Increased Infectious Risk Kidney Offer Acceptance

Courtenay M. Holscher, Mary G. Bowring, Christine E. Haugen, Sheng Zhou, Allan B. Massie, Sommer E. Gentry, Dorry L. Segev, Jacqueline M. Garonzik Wang

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2157-2163
Number of pages7
JournalTransplantation
Volume103
Issue number10
DOIs
StatePublished - Oct 1 2019

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Communicable Diseases
Kidney
Odds Ratio
Tissue Donors
Confidence Intervals
Transplants
Registries
Logistic Models
Survival

ASJC Scopus subject areas

  • Transplantation

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National Variation in Increased Infectious Risk Kidney Offer Acceptance. / Holscher, Courtenay M.; Bowring, Mary G.; Haugen, Christine E.; Zhou, Sheng; Massie, Allan B.; Gentry, Sommer E.; Segev, Dorry L.; Garonzik Wang, Jacqueline M.

In: Transplantation, Vol. 103, No. 10, 01.10.2019, p. 2157-2163.

Research output: Contribution to journalArticle

Holscher, Courtenay M. ; Bowring, Mary G. ; Haugen, Christine E. ; Zhou, Sheng ; Massie, Allan B. ; Gentry, Sommer E. ; Segev, Dorry L. ; Garonzik Wang, Jacqueline M. / National Variation in Increased Infectious Risk Kidney Offer Acceptance. In: Transplantation. 2019 ; Vol. 103, No. 10. pp. 2157-2163.
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abstract = "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.",
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AU - Massie, Allan B.

AU - Gentry, Sommer E.

AU - Segev, Dorry L.

AU - Garonzik Wang, Jacqueline M.

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N2 - 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.

AB - 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.

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