Disparities in Death and Delisting on the Waitlist for Renal Transplant in the United States
Medicine, University of Virginia, Charlottesville, VA.
Meeting: 2015 American Transplant Congress
Abstract number: 43
Keywords: Cadaveric organs, Kidney transplantation, Mortality, Waiting lists
Session Information
Session Name: Concurrent Session: Kidney Utilization/Center Issues
Session Type: Concurrent Session
Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:39pm-2:51pm
Location: Room 121-AB
Waiting time to kidney transplant varies dramatically among organ procurement organizations (OPOs) in the US. We sought to evaluate the association between death and delisting due to poor health (DDL) among primary waitlisted candidates for kidney or kidney-pancreas (KP) transplant and median waiting time to transplant and living donor (LD) rates for the OPO of listing.
We reviewed all 110,011 candidates listed for kidney or KP transplant between 2001 and 2005 in the SRTR database and followed until August 31, 2013. We sought to evaluate the rates of DDL as a function of OPO of listing. Logistic regression was performed for the outcome of DDL and model covariates included candidate age, gender, ABO type, race, etiology of kidney disease, initial status at listing (inactive vs. active), dialysis status at listing, presence of multiple listings, and primary insurance.
Longer median wait times for an OPO were associated with higher rates of DDL. By the end of the study period, 20.8% of candidates either died on the waiting list or were delisted for health reasons. The odds of DDL varied by a factor of 14 [OR 0.25 (C.I. 0.09-0.50) to OR 3.67 (C.I. 3.46-3.90)] among the 58 OPOs. The absolute difference among the rates of DDL ranged from 4.2% to 37.3%. OPOs were stratified by LD rates and median waiting time to deceased donor transplant. In OPOs with a median waiting time of 6 or more years the OR for death on the waiting list was 4.01 (C.I. 3.64-4.43) compared to OPOs with a median waiting time of 1.5 years or less (Figure 1). Higher LD rates were associated with reduced risk of death on the waiting list with OPOs with greater than 40% of candidates receiving a LD having an OR of DDL of 0.44 (C.I. 0.39-0.49) compared to OPOs with LD rates of less than 15%.
Candidates listed in OPOs with longer waiting times and lower LD rates are at greater risk of dying or becoming too sick for kidney transplant on the waitlist. Organ allocation policy changes should be considered to better equalize this burden among all candidates awaiting kidney transplant. 
To cite this abstract in AMA style:
Keith D, Lucar ANishio, Vranic G. Disparities in Death and Delisting on the Waitlist for Renal Transplant in the United States [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/disparities-in-death-and-delisting-on-the-waitlist-for-renal-transplant-in-the-united-states/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress