Association of the Kidney Allocation System with Dialysis Exposure Before Deceased Donor Kidney Transplantation by Preemptive Wait-listing Status

Overview

Journal Clin Transplant

Specialty General Surgery

Date 2018 Aug 23

PMID 30132986

Citations 4

Authors

Meera N Harhay

Michael O Harhay

Karthik Ranganna

Suzanne M Boyle

Lissa Levin Mizrahi

Stephen Guy

Gregory E Malat

Gary Xiao

David J Reich

Rachel E Patzer

Affiliations

Soon will be listed here.

Abstract

Background: It is unknown whether the new kidney transplant allocation system (KAS) has attenuated the advantages of preemptive wait-listing as a strategy to minimize pretransplant dialysis exposure.

Methods: We performed a retrospective study of adult US deceased donor kidney transplant (DDKT) recipients between December 4, 2011-December 3, 2014 (pre-KAS) and December 4, 2014-December 3, 2017 (post-KAS). We estimated pretransplant dialysis durations by preemptive listing status in the pre- and post-KAS periods using multivariable gamma regression models.

Results: Among 65 385 DDKT recipients, preemptively listed recipients (21%, n = 13 696) were more likely to be white (59% vs 34%, P < 0.001) and have private insurance (64% vs 30%, P < 0.001). In the pre- and post-KAS periods, average adjusted pretransplant dialysis durations for preemptively listed recipients were <2 years in all racial groups. Compared to recipients who were listed after starting dialysis, preemptively listed recipients experienced 3.85 (95% Confidence Interval [CI] 3.71-3.99) and 4.53 (95% CI 4.32-4.74) fewer average years of pretransplant dialysis in the pre- and post-KAS periods, respectively (P < 0.001 for all comparisons).

Conclusions: Preemptively wait-listed DDKT recipients continue to experience substantially fewer years of pretransplant dialysis than recipients listed after dialysis onset. Efforts are needed to improve both socioeconomic and racial disparities in preemptive wait-listing.

Citing Articles

Geographic hot spots of kidney transplant candidates wait-listed post-dialysis.

Buchalter R, Huml A, Poggio E, Schold J Clin Transplant. 2022; 36(12):e14821.

PMID: 36102154 PMC: 10078213. DOI: 10.1111/ctr.14821.

A scoping review of inequities in access to organ transplant in the United States.

Park C, Jones M, Kaplan S, Koller F, Wilder J, Boulware L Int J Equity Health. 2022; 21(1):22.

PMID: 35151327 PMC: 8841123. DOI: 10.1186/s12939-021-01616-x.

Harhay M, Yang W, Sha D, Roy J, Chai B, Fischer M Kidney Med. 2020; 2(5):600-609.e1.

PMID: 33089138 PMC: 7568061. DOI: 10.1016/j.xkme.2020.06.010.

An overview of frailty in kidney transplantation: measurement, management and future considerations.

Harhay M, Rao M, Woodside K, Johansen K, Lentine K, Tullius S Nephrol Dial Transplant. 2020; 35(7):1099-1112.

PMID: 32191296 PMC: 7417002. DOI: 10.1093/ndt/gfaa016.

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