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. 2019 Aug 2;2(8):e1910312.
doi: 10.1001/jamanetworkopen.2019.10312.

Association Between Declined Offers of Deceased Donor Kidney Allograft and Outcomes in Kidney Transplant Candidates

S Ali Husain  1   2 , Kristen L King  1   2 , Stephen Pastan  3 , Rachel E Patzer  4   5 , David J Cohen  1 , Jai Radhakrishnan  1 , Sumit Mohan  1   2   6
Affiliations

Association Between Declined Offers of Deceased Donor Kidney Allograft and Outcomes in Kidney Transplant Candidates

S Ali Husain et al. JAMA Netw Open. .

Erratum in

  • Error in Author Name.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 Oct 2;2(10):e1914599. doi: 10.1001/jamanetworkopen.2019.14599. JAMA Netw Open. 2019. PMID: 31603479 Free PMC article. No abstract available.

Abstract

Importance: In the United States, substantial disparities in access to kidney transplant exist for wait-listed candidates with end-stage renal disease. The implications of transplant centers' willingness to accept kidney offers for access to transplant and mortality outcomes are unknown.

Objective: To determine the outcomes for wait-listed kidney transplant candidates after the transplant center's refusal of a deceased donor kidney offer.

Design, setting, and participants: This cohort study obtained data from the United Network for Organ Sharing Potential Transplant Recipient data set on all deceased donor kidney offers in the United States made between January 1, 2008, and December 31, 2015. The final study cohort included adult patients who were wait-listed for kidney transplant and received at least 1 allograft offer during the study period (N = 280 041). Data analysis was conducted from June 1, 2018, to March 30, 2019.

Exposure: Candidate state of residence.

Main outcomes and measures: Waiting list outcome event groups included received deceased donor allograft, received living donor allograft, died while on the waiting list, removed from the waiting list without a transplant, or still on the waiting list at the end of follow-up.

Results: Among the 280 041 kidney transplant candidates included in the study, the mean (SD) age at wait-listing was 51.1 (13.1) years, and male patients were predominant (171 517 [61.2%]). In this cohort, 81 750 candidates (29.2%) received a deceased donor kidney allograft, 30 870 (11.0%) received a living donor allograft, 25 967 (9.3%) died while on the waiting list, and 59 359 (21.2%) were removed from the waiting list. Overall, 10 candidates with at least 1 previous allograft offer died each day during the study period. Time to first offer was similar for candidates who received deceased donor kidney allograft compared with those who died while waiting (median [interquartile range {IQR}] time, 79 [16-426] days vs 78 [17-401] days, respectively). Deceased donor allograft recipients had a median of 17 offers (IQR, 6-44) over 422 days (IQR, 106-909 days), whereas candidates who died while waiting received a median of 16 offers (IQR, 6-41) over 651 days (IQR, 304-1117 days). Most kidneys (84%) were declined on behalf of at least 1 candidate before being accepted for transplant. As reported by centers, organ or donor quality concerns accounted for 8 416 474 (92.6%) of all declined offers, whereas offers were infrequently refused because of patient-related factors (232 193 [2.6%]), logistical limitations (49 492 [0.5%]), or other concerns. The odds of death after an offer and the median number of offers received prior to death varied considerably by state.

Conclusions and relevance: This study found that transplant candidates appeared to receive a large number of viable deceased donor kidney offers that were refused on their behalf by transplant centers, potentially exacerbating the detrimental consequences of the organ shortage; increased transparency in organ allocation process and decisions may improve patient-centered care and access to kidney transplant.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Husain reported receiving grants from the National Kidney Foundation during the conduct of the study. Dr Pastan reported having a past joint venture relationship with Fresenius Medical Care that resulted in binding arbitration to resolve a legal dispute. Dr Pazter reported receiving grants from the National Institutes of Health (NIH) outside the submitted work. Dr Mohan reported receiving grants from the NIH, and personal fees from HSAG, CMS, Angion Pharmaceuticals, and Kidney International Reports outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adjusted Odds Ratio for Death While on the Waiting List After Receipt of at Least 1 Deceased Donor Kidney Offer, by Candidate State of Residence, 2008-2015
Maine, the state with the lowest odds of death while on the waiting list after receiving an offer, was the reference state. The model was adjusted for age, body mass index category, presence of diabetes, and presence of vascular disease at listing, and was adjusted for race/ethnicity, preemptive status, peak calculated panel reactive antibody, and number of days between listing and first offer.
Figure 2.
Figure 2.. Median Number of Deceased Donor Kidney Offers to Those Who Died While on the Waiting List by Adjusted Odds of Death on the Waiting List, by Candidate State of Residence, 2008-2015.
Maine, the state with the lowest odds of death on the waiting list after receiving an offer, was the reference state.
See this image and copyright information in PMC

References

    1. Mohan S, Mutell R, Patzer RE, Holt J, Cohen D, McClellan W. Kidney transplantation and the intensity of poverty in the contiguous United States. Transplantation. 2014;98(6):-. doi:10.1097/TP.0000000000000125 - DOI - PMC - PubMed
    1. Mathur AK, Ashby VB, Sands RL, Wolfe RA. Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation. Am J Transplant. 2010;10(4 Pt 2):1069-1080. doi:10.1111/j.1600-6143.2010.03043.x - DOI - PubMed
    1. Davis AE, Mehrotra S, McElroy LM, et al. . The extent and predictors of waiting time geographic disparity in kidney transplantation in the United States. Transplantation. 2014;97(10):1049-1057. doi:10.1097/01.tp.0000438623.89310.dc - DOI - PubMed
    1. Mohan S, Chiles MC. Achieving equity through reducing variability in accepting deceased donor kidney offers [published online July 27, 2017]. Clin J Am Soc Nephrol. 2017. doi:10.2215/CJN.06220617 - DOI - PMC - PubMed
    1. Wolfe RA, Ashby VB, Milford EL, et al. . Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-1730. doi:10.1056/NEJM199912023412303 - DOI - PubMed

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