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The aggressive phenotype: center-level patterns in the utilization of suboptimal kidneys

J M Garonzik-Wang1, N T James, K C Weatherspoon

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|October 14, 2011
PubMed

Insights

Transplant centers vary in their aggressive use of suboptimal kidneys. Factors like wait-list size, organ shortage, and waiting times influence this aggressive phenotype, impacting kidney transplant outcomes.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Health Services Research

Background:

  • Suboptimal kidneys, despite poorer outcomes, are utilized variably due to differing wait times and wait-list mortality.
  • It remains unclear if transplant centers exhibit an aggressive phenotype in using various types of suboptimal grafts concurrently.
  • Understanding center characteristics associated with aggressive suboptimal graft utilization is crucial for optimizing kidney transplant practices.

Purpose of the Study:

  • To investigate whether transplant centers' aggressive use of one type of suboptimal kidney graft correlates with the aggressive use of other types.
  • To identify center-specific characteristics associated with an overall aggressive phenotype in utilizing suboptimal kidney grafts.
  • To explore the impact of wait-list dynamics, organ availability, and center operational factors on transplant aggressiveness.

Main Methods:

  • Utilized United Network for Organ Sharing (UNOS) data from 2005-2009 for adult kidney transplant recipients.
  • Aggregated data to the center level and assigned an aggressiveness score based on suboptimal graft usage.
  • Employed cluster analysis to identify patterns in aggressive utilization across different graft types and correlated aggressiveness with center characteristics.

Main Results:

  • Aggressiveness in suboptimal kidney utilization was associated with wait-list size, organ shortage, and longer waiting times.
  • Higher transplant volumes did not consistently correlate with aggressiveness, unlike in lower-volume centers.
  • Aggressive centers were predominantly located in specific geographic regions (2 and 9), and none were found in single-center Organ Procurement Organizations (OPOs).

Conclusions:

  • Wait-list size, waiting times, geographic region, and OPO competition are significant drivers of center-level aggressiveness in utilizing suboptimal kidney grafts.
  • While some centers show consistent aggressive or non-aggressive patterns, others exhibit intermediate phenotypes with varied suboptimal kidney usage.
  • These findings highlight the complex interplay of systemic and operational factors influencing organ allocation strategies and transplant center behavior.

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