Kidney transplant (KTxp) program quality is assessed by risk adjusted wait list (WL) mortality, time to deceased donor (DD) Txp, and patient (pt) and graft survival. The best outcome for KTxP candidates is living donor (LD) Txp, yet quality metrics for achieving LD Txp for a given Txp candidate population do not exist.
PURPOSE: to evaluate LD conversion rate (LDCR) as a metric for programmatic efficiency in achieving LD Txp.
METHODS: SRTR center-specific data for FY 2011 for US adult KTxp programs were analyzed. LDCR was calculated by #LD Txp/#new wait list registrations (WLR) x 100%. Adjusted LDCR took into account LDs that were not waitlisted and was calculated by: #LD Txps/#LD Txps + #new WLR x 100%. LDCR therefore expresses LD Txp rates in terms of wait listing volume, giving an indicator of the proportion of KTxp candidates in whom LD Txp is achieved.
RESULTS: Data from 202 programs were analyzed. LD Txp volume provided a mean of 27.9 + 29.4 LD Txp/program (median 18, range 0-154). % of Txp as LD for each program provided a mean of 32.8 + 16.5% (median 31.6%, range 0 -100%). LDCR and adjusted LDCR values demonstrated marked heterogeneity (see figure): mean of 14.2 + 0.74% (median 13.2%, range 0 – 40.8%). Figure demonstrates LDCR for US KTxp programs.
Several factors were analyzed for effect on LDCR: %Txp as LD, LD Txp volume, DD Txp volume, %WLR as African Americans (AA), %WLR as nonAA, %LD Txp as AA, %LD Txp as nonAA. The strongest correlation with LDCR was %Txp as LD (r=0.61, p<0.0001)(Fig3) and the %WLR as nonAA (r=0.27, p<0.0001). Additional analyses are evaluating the effect of WL prior to LD Txp (ie, double counting).
CONCLUSIONS: LDCR vary widely. The strongest effect on LDCR was %Txp as LD, suggesting that program emphasis on LD Txp exerts a strong effect. LDCRs also vary based on Txp candidate demographics. LDCR is likely a modifiable factor, and since LD Txp provides optimal outcomes, LDCR may provide a useful metric for assessing Txp program quality. LDCR can likely be adjusted for factors that influence ability to achieve LD Txp such as race.
To cite this abstract in AMA style:Woodle E, Woodle B, Girnita A, Cuffy M, Shah S, Schold J, Gill J. Living Donor Conversion Rate as a Quality Measure for Kidney Transplant Programs [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/living-donor-conversion-rate-as-a-quality-measure-for-kidney-transplant-programs/. Accessed September 23, 2017.
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