Center-Level Probability of Kidney Transplant Varies Considerably for Waitlisted Patients
1Columbia University, New York, NY, 2University of Pennsylvania, Philadelphia, PA, 3Cleveland Clinic, Cleveland, OH, 4Emory University, Atlanta, GA
Meeting: 2019 American Transplant Congress
Abstract number: 502
Keywords: Allocation, Kidney transplantation, Resource utilization, Waiting lists
Session Information
Session Name: Concurrent Session: Non-Organ Specific: Disparities and Access to Healthcare I
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Room 208
*Purpose: Prior studies identify reducing time spent on the waitlist as a top priority for deceased donor kidney (DDK) transplant (Tx) candidates. Despite well-described geographic variation in access to transplantation, little is known about center variability in access to Tx. We assess center-level probability of deceased donor transplantation both between and within UNOS regions.
*Methods: Using 2018 SRTR data, we identified two incident cohorts of first-time adult DDK Tx candidates: 32,724 waitlisted in 2011 pre-KAS (Kidney Allocation System), and 24,766 beginning dialysis or listed preemptively in 2015 (post-KAS). We calculated the cumulative incidence function for the probability of receiving a DDK Tx at 3 years of follow-up for each cohort at the center, regional, and national levels using competing risk regression with living donor Tx, death, and waitlist removal as competing events.
*Results: Nationwide, the probability of receiving a DDK Tx within 3 years was 13.7% (SE: 0.17) pre-KAS and 12.6% (0.25) post-KAS. Probability of Tx varied across UNOS regions pre-KAS, from 9.1% (Region 4) to 23.8% (Region 8). Post-KAS, Region 8 again had the highest probability (17.1%), but Region 1 had the lowest (7.8%). There was even greater variation in probability of Tx within each region when comparing centers performing 10+ DDK Tx per year. Pre-KAS, Region 3 had the widest range between centers (3.2-48.5%), and Region 9 had the narrowest (0.6-17.9%). Post-KAS, Region 9 had the widest range (2.0-67.2%), and Region 1 had the smallest (1.6-16.0%).
*Conclusions: Although regional heterogeneity in the probability of receiving a DDK is not surprising given geographic variation in organ availability, we found considerable variation between centers within each region for both cohorts even when accounting for varying rates of living donor Tx and death as competing events. Further exploration of how center-level waitlist management and organ offer acceptance impact probability of receiving a DDK is warranted.
To cite this abstract in AMA style:
King KL, Husain SA, Reese P, Schold J, Pastan S, Mohan S. Center-Level Probability of Kidney Transplant Varies Considerably for Waitlisted Patients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/center-level-probability-of-kidney-transplant-varies-considerably-for-waitlisted-patients/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress