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Comparative Study
. 2019 Jul;103(7):1450-1456.
doi: 10.1097/TP.0000000000002508.

Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors

Rhiannon D Reed  1 , Paul A MacLennan  1 , Brittany A Shelton  1 , Margaux N Mustian  1 , Justin Blackburn  2 , Sharmene C Smith  1 , Kristin B Terry  1 , Raynesha Grant  1 , Deirdre Sawinski  3 , Jayme E Locke  1
Affiliations
Comparative Study

Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors

Rhiannon D Reed et al. Transplantation. 2019 Jul.

Abstract

Background: Living kidney donors in the United States who were obese at donation are at increased risk of end-stage renal disease and may benefit from intensive postdonation follow-up. However, they are less likely to have complete follow-up data. Center variation and risk factors for incomplete follow-up are unknown.

Methods: Adult living kidney donors with obesity (body mass index, ≥30 kg/m) at donation reported to the Scientific Registry of Transplant Recipients from January 2005 to July 2015 were included (n = 13 831). Donor characteristics were compared by recorded serum creatinine at 6 months postdonation, and multilevel logistic regression models were used to estimate odds of 6-month creatinine.

Results: After adjustment, older age, female sex, and donation after implementation of new center follow-up requirements were associated with higher odds of 6-month creatinine, with lower odds for obese donors with a history of smoking, biologically related donors, and at centers with higher total living donor volume. 23% of variation in recorded 6-month serum creatinine among obese donors was attributed to center (intraclass correlation coefficient: 0.232, P < 0.001). The adjusted probability of 6-month creatinine by center ranged from 10% to 91.5%.

Conclusions: Tremendous variation in recorded 6-month postdonation serum creatinine exists among obese living donors, with high volume centers having the lowest probability of follow-up. Moreover, individual-level characteristics such as age, sex, and relationship to recipient were associated with recorded 6-month creatinine. Given increased risk for end-stage renal disease among obese living donors, center-level efforts targeted specifically at increasing postdonation follow-up among obese donors should be developed and implemented.

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Figures

Figure 1.
Figure 1.
Frequency of obese living donors by recovery center
Figure 2.
Figure 2.
Scatterplot of total obese donors recovered per center by percent of donors with a 6-month serum creatinine
Figure 3.
Figure 3.
Predicted probability of 6-month creatinine measurement by recovery center
See this image and copyright information in PMC

References

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