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National Variation in Increased Infectious Risk Kidney Offer Acceptance
Courtenay M Holscher1, Mary G Bowring1, Christine E Haugen1
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Transplantation
|July 26, 2019
Summary
Infectious disease (IRD) kidney offers are often declined, limiting access to life-saving transplants. Wide national variation exists in acceptance rates, suggesting opportunities to improve organ utilization for kidney transplant candidates.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Kidney offers from infectious disease (IRD) donors provide survival benefits but are declined 1.5 times more often than non-IRD kidneys.
- Understanding variations in IRD kidney offer acceptance is crucial for increasing the use of these vital organs.
Purpose of the Study:
- To investigate center-level variations in the acceptance of infectious disease (IRD) kidney offers.
- To identify factors influencing the acceptance rates of IRD kidney offers across different transplant centers.
Main Methods:
- A retrospective analysis of 6,765 transplanted IRD kidneys offered to 187 transplant centers from 2009-2017.
- Multilevel logistic regression was used to analyze offer acceptance, controlling for donor and center characteristics.
Main Results:
- Higher kidney quality, increased transplant center volume, smaller waitlist size, and fewer local transplant centers were associated with higher IRD kidney acceptance.
- Significant heterogeneity in IRD offer acceptance was observed, with a median odds ratio (MOR) of 1.96, indicating substantial center-level variation.
Conclusions:
- Wide national disparities in infectious disease (IRD) kidney offer acceptance limit patient access to life-saving organs.
- Addressing these variations could expand the utilization of IRD kidneys and improve outcomes for transplant candidates.
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