Defining pre-emptive living kidney donor transplantation as a quality indicator

Area of Science:

• Nephrology
• Transplantation Medicine
• Health Services Research

Background:

• Quality indicators are essential for evaluating and improving kidney transplant care.
• Pre-emptive living donor kidney transplantation aims to improve patient outcomes by avoiding dialysis.
• Standardized definitions are needed to accurately measure access to pre-emptive living donor kidney transplants.

Purpose of the Study:

• To examine multiple definitions of pre-emptive living donor kidney transplants.
• To assess the impact of varying patient cohorts and censoring definitions on transplant incidence rates.
• To provide a framework for developing quality indicators for kidney transplantation.

Main Methods:

• Utilized linked administrative health care databases in Ontario, Canada (2013-2018).
• Created four distinct patient cohorts based on progression risk and transplant contraindications.
• Explored the effect of four different censoring event definitions on the data.

Main Results:

• Patient cohort sizes varied significantly (20,663 to 9,598) based on definition criteria.
• Excluding patients with contraindications reduced cohort size by 43%.
• Pre-emptive living donor kidney transplant incidence rates ranged from 1.02 to 2.21 per 100 person-years across cohorts.

Conclusions:

• The definition of pre-emptive living donor kidney transplants critically influences cohort size and incidence rates.
• These findings offer a methodological framework for developing and monitoring kidney transplant quality indicators.
• Improved definitions can enhance the assessment and accessibility of pre-emptive living donor kidney transplants.