Backdating Waiting Time to Date of First Maintenance Dialysis Significantly Reduces Median Time To Transplant for Kidney Transplant Candidates with Long Pre-Waitlisting Dialysis Duration
U of Michigan, Ann Arbor
Arbor Research Collaborative for Health, Ann Arbor
U of California, Los Angeles
Meeting: 2013 American Transplant Congress
Abstract number: A781
Insurance type and minority status are associated with large disparities in the duration of pre-waitlisting dialysis (PWLD) among candidates for kidney transplantation. To partially redress this disparity the Organ Procurement and Transplantation Network (OPTN) adopted a variance to allow donor service areas to calculate waiting time from the earlier of the date that GFR was < 20 ml/min for preemptively waitlisted candidates, or the date of first maintenance dialysis for those with PWLD. The Gift of Life Michigan (GOLM) and One Legacy (OL) organ procurement organizations implemented this alternative system on 4/29/2006.
Data from the SRTR were merged with national CMS ESRD data on first waitlistings for active and inactive kidney transplant candidates. A Cox model was fit to obtain median time to transplant (MTT) in the 6 years before (5/1/00-4/28/06) and after (4/29/06-5/31/12) implementation, stratified by PWLD. Censoring occurred at the earliest of death, removal from waitlist, or end of follow-up.
MTT increased nationally and at GOLM and OL post-variance (Table). However, GOLM and OL saw significant reductions in MTT for candidates with longer PWLD (Table). MTT was more than halved for candidates with ≥ 3 years PWLD at GOLM and ≥ 5 years at OL. Similar patterns were seen with black candidates.
Backdating of waiting time to the date of first maintenance dialysis for candidates who are waitlisted after starting dialysis has significantly reduced MTT among this population. Implementation of this variance as national policy should be supported as a key element in the current OPTN kidney allocation proposal.
| MTT in years (95% C.I.) | ||||||
| US | GOLM | OL | ||||
| PWLD (years) | Pre | Post | Pre | Post | Pre | Post |
| All | 4.0 (3.9 – 4.0) | 4.9 (4.8 – 4.9) | 4.1 (3.9 – 4.3) | 4.6 (4.3 – 4.9) | 4.7 (4.6 – 5.0) | 5.9 (5.8 – NC†) |
| 0-1* | 4.0 (3.9 – 4.0) | 4.9 (4.8 – 5.0) | 4.0 (3.7 – 4.3) | 5.4 (5.1 – 5.6) | 4.5 (4.3 – 4.7) | NC† |
| 1-3 | 3.9 (3.8 – 4.0) | 4.8 (4.7 – 4.9) | 4.3 (3.7 – 4.7) | 3.7 (3.5 – 4.0) | 5.0 (4.5 – 5.1) | 5.9 (5.8 – NC†) |
| 3-5 | 3.9 (3.7 – 4.2) | 4.7 (4.3 – 4.9) | 4.2 (3.1 – 4.3) | 1.7 (1.4 – 2.1) | 5.0 (4.7 – 5.7) | 4.9 (4.7 – 5.1) |
| 5+ | 4.4 (4.1 – 4.8) | 4.8 (4.6 – 5.1) | 3.6 (3.1 – 4.8) | 0.5 (0.4 – 0.7) | 4.7 (4.3 – 5.0) | 1.9 (1.5 – 2.2) |
To cite this abstract in AMA style:
Leichtman A, Wisniewski K, Ashby V, Merion R, Danovitch G. Backdating Waiting Time to Date of First Maintenance Dialysis Significantly Reduces Median Time To Transplant for Kidney Transplant Candidates with Long Pre-Waitlisting Dialysis Duration [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/backdating-waiting-time-to-date-of-first-maintenance-dialysis-significantly-reduces-median-time-to-transplant-for-kidney-transplant-candidates-with-long-pre-waitlisting-dialysis-duration/. Accessed May 17, 2025.« Back to 2013 American Transplant Congress