Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

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The Sum of Kidney Donor Profile Index and Estimated Post-Transplant Survival Scale and Their Correlation with eGFR Decline in Deceased Donor Kidney Recipients

Revista de investigaci�n Cl�nica ◽

10.24875/ric.20000618 ◽

2021 ◽

Author(s):

Pablo Maggiani-Aguilera ◽

Sergio Hernández-Estrada ◽

José H. Cano-Cervantes ◽

Jonathan S. Chávez-Iñiguez ◽

Christian Pérez-Flores ◽

...

Keyword(s):

Deceased Donor ◽

Kidney Donor ◽

Donor Kidney ◽

Transplant Survival ◽

Post Transplant ◽

Kidney Recipients ◽

Deceased Donor Kidney ◽

Egfr Decline

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Primary pediatric deceased‐donor kidney transplant recipients outcomes by immunosuppression induction received in the United States

Pediatric Transplantation ◽

10.1111/petr.13928 ◽

2020 ◽

Author(s):

Samy Riad ◽

Scott Jackson ◽

Srinath Chinnakotla ◽

Priya Verghese

Keyword(s):

United States ◽

Kidney Transplant ◽

Deceased Donor ◽

The United States ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Deceased Donor Kidney Transplant

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Trends in Disparities in Preemptive Kidney Transplantation in the United States

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03140319 ◽

2019 ◽

Vol 14 (10) ◽

pp. 1500-1511 ◽

Cited By ~ 9

Author(s):

Kristen L. King ◽

Syed Ali Husain ◽

Zhezhen Jin ◽

Corey Brennan ◽

Sumit Mohan

Keyword(s):

United States ◽

Kidney Transplantation ◽

Private Insurance ◽

Deceased Donor ◽

The United States ◽

Transplant Recipients ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Medicare Patients ◽

Preemptive Transplantation

Background and objectivesLong wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed.Design, setting, participants, & measurementsWe identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models.ResultsThe proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P<0.05). Medicare patients had a significantly lower odds of preemptive transplantation relative to private insurance holders (pre-KAS adjusted OR, [aOR] 0.26; [95% CI, 0.25 to 0.27], to 0.20 [95% CI, 0.18 to 0.22] post-KAS). Black and Hispanic patients experienced a similar phenomenon (aOR 0.48 [95% CI, 0.45 to 0.51] to 0.41 [95% CI, 0.37 to 0.45] and 0.43 [95% CI, 0.40 to 0.47] to 0.40 [95% CI, 0.36 to 0.46] respectively) compared with white patients.ConclusionsAlthough the proportion of deceased donor kidney transplants performed preemptively increased slightly after KAS, disparities in preemptive kidney transplantation persisted after the 2014 KAS policy changes and were exacerbated for racial minorities and Medicare patients.

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