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New variables reported to the UNOS registry and their impact on cadaveric renal transplant outcomes - a preliminary
Y W Cho1, P I Terasaki, J M Cecka
1UCLA Tissue Typing Laboratory, Los Angeles, California, USA.
Abstract:
Several new factors collected by UNOS since 1994 were examined with regard to their effects on early graft function and 6-month graft survival in this study. Medicare patients had a lower 6-month graft survival rate than private insurance patients, though the difference was not statistically significant. Medicaid patients had a significantly lower graft survival rate than private insurance patients (p=0.04). Blacks had the same graft survival as Whites when they had comparable coverage. Both Blacks and Whites had higher graft survival with private insurance and lower survival with government funding. Non-heartbeating cadaver-donor kidneys yielded a lower graft survival rate than heartbeating donors (p=0.03). Experience with non-heartbeating donors is just beginning with only 89 kidneys compared with 8,766 heartbeating donor kidneys. Kidneys from donors with hypertension resulted in lower graft survival rates than those from donors without hypertension (p=0.01). In these preliminary studies, donor history of diabetes, smoking, alcohol dependency, I.V. drug use and cancer did not have a significant impact on graft survival. Patients who had a high body mass index (>26) had a lower 6-month graft survival rate (p=0.009). Patients who received kidneys from cadaver donors with a low body mass index (<20) had a lower 6-month graft survival rate (p=0.02). When the recipient was more than 30 kg heavier than the donor, a lower 6-month graft survival rate was obtained (p=0.007). When the weight ratio was greater than 2.0, again a lower survival was noted (p<0.001). A recipient-to-donor height ratio of more than 1.25 resulted in an 80% 6-month graft survival which was significantly less than the 87% survival rate among those with a ratio less than 1.25 (p<0.001). This cut-off was found to identify patients with the lowest 6-month survival rate, suggesting that donor-recipient pairs with a height ratio above 1.25 should not be transplanted. A 6-month graft survival rate of 90% was reported with a SMI of 16-20, where SMI = weight of recipient divided by the square of the donor height. From this preliminary study, the SMI appears to be the best predictor of high graft survival since 1,450 patients were in this category with a 90% survival at 6 months.
Insights
Kidney transplant survival is impacted by insurance type, donor factors like hypertension, and recipient-donor size mismatches. Medicaid patients and recipients with significant height or weight differences show lower graft survival rates.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Understanding factors influencing graft survival is crucial for optimizing outcomes.
- The United Network for Organ Sharing (UNOS) collects data on various donor and recipient characteristics.
Purpose of the Study:
- To investigate the impact of newly collected UNOS factors on early graft function and 6-month graft survival.
- To identify key predictors of kidney transplant success.
Main Methods:
- Analysis of UNOS data collected since 1994.
- Comparison of graft survival rates based on insurance status, donor characteristics (hypertension, body mass index), and recipient-donor anthropometric ratios.
- Statistical analysis to determine significance (p-values).
Main Results:
- Medicaid patients had significantly lower graft survival than private insurance patients (p=0.04).
- Non-heartbeating cadaver donors and donors with hypertension showed lower graft survival (p=0.03 and p=0.01, respectively).
- Higher recipient-to-donor weight ratios (>2.0) and height ratios (>1.25) were associated with significantly lower graft survival (p<0.001).
- A recipient-to-donor height ratio above 1.25 was identified as a predictor of poor outcomes.
- A recipient-to-donor size index (SMI) of 16-20 predicted high 6-month graft survival (90%).
Conclusions:
- Insurance status, donor hypertension, and significant recipient-donor size discrepancies negatively impact kidney graft survival.
- Recipient-donor anthropometric ratios, particularly height, are critical factors to consider in transplant decisions.
- The SMI shows promise as a predictor of successful kidney transplant outcomes.