Is There an Association Between Number of Outpatient Primary Care Visits (OPV) and Outcomes in Kidney Transplantation (KTP)?
Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
Department of Veterans Affairs, Comprehensive Access and Delivery Research Evaluation (CADRE), Iowa City, IA
Meeting: 2017 American Transplant Congress
Abstract number: 521
Keywords: Kidney transplantation, Risk factors, Survival
Session Information
Session Name: Concurrent Session: Kidney General Outcomes
Session Type: Concurrent Session
Date: Tuesday, May 2, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: E354a
Background: Periodic outpatient primary care visits (PCV) after KTP is recommended to achieve optimal outcomes, but annual rates of PCV by KTP recipients is not known as PCV is typically not provided by the same institution where the KTP was performed. Whether frequency of PCV has an impact on KTP outcomes is not known. The goal of our study is to examine the impact of the annual number of PCVs on patient survival in the VA system where accurate PCV nationwide data is available.
Methods: A retrospective study of Veterans receiving KTP via a VA transplant center from March 2000 to December 2014 using electronic medical records from VHA linked to KTP data from UNOS. All PCV conducted at the VA system after KTP through September 2016 were included. All non-transplant subspecialty visits were excluded. The average number of annual PCVs was used to examine impact on patient survival. Logistic regression models included adjustments for donor and recipient variables, and comorbidity composite score based on Quan et al.
Results: 1307 KTP were studied. 1080 are alive and 227 deceased. Most common causes of death were cancer (13.2%) and cardiovascular (12.8%). Overall patient and graft survival (days – mean±SE) were 1567±33 and 1532±33, respectively. On average, patients had 9±8 PCV appointments per year. Patients who died were older (p<0.0001), had a lower number of PCV per year compared to patients who remain alive (p<0.0001), and had more comorbid conditions within the year of transplant. In a logistic regression model, a higher average annual PCV was associated with a lower risk of death.
| Variable | Estimate (SE) | OR (95% CI) | Test of Fixed Effects |
| Average Primary Care Appointment/Year[sup1] | -0.88 (0.15) | 0.42 (0.31, 0.56) | <0.001 |
| Recipient age | 0.37 (0.09) | 1.45 (1.21, 1.75) | <0.001 |
| Time from wait list to transplant | -0.24 (0.07) | 0.79 (0.69, 0.90) | <0.001 |
| Summation of comorbid conditions | 0.26 (0.06) | 1.3 (1.17, 1.45) | <0.001 |
[sup1]OR represents increase of 10 PCVs/year
Conclusions: In the VA system, frequency of PCV is associated with a lower risk of death. Assurance that KTP recipients are following with PCV should contribute to improved long-term outcomes. Further studies in larger national datasets are needed to evaluate this association.
CITATION INFORMATION: O'Shea A, Kalil R. Is There an Association Between Number of Outpatient Primary Care Visits (OPV) and Outcomes in Kidney Transplantation (KTP)? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
O'Shea A, Kalil R. Is There an Association Between Number of Outpatient Primary Care Visits (OPV) and Outcomes in Kidney Transplantation (KTP)? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/is-there-an-association-between-number-of-outpatient-primary-care-visits-opv-and-outcomes-in-kidney-transplantation-ktp/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress