Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait-listing status

• Type of Material: Article
• Authors: Meera Nair Harhay, Drexel University; Michael O. Harhay, University of Pennsylvania; Karthik Ranganna, Drexel University; Suzanne M. Boyle, Drexel University; Lissa Levin Mizrahi, Drexel University; Stephen Guy, Drexel University; Gregory E. Malat, Drexel University; Gary Xiao, Drexel University; David J. Reich, Drexel University; Rachel Patzer, Emory University
• Language: English
• Date: 2018-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
• Final Published Version (URL): http://dx.doi.org/10.1111/ctr.13386
• Title of Journal or Parent Work: Clinical Transplantation
• ISSN: 0902-0063
• Volume: 32
• Issue: 10
• Start Page: e13386
• End Page: e13386
• Grant/Funding Information: MNH is supported by a grant (K23DK105207) from the National Institutes of Health (NIH)/National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK).; This work was supported in part by Health Resources and Services Administration contract 234–2005-37011C.; MOH is supported by a grant (K99HL141678) from the NIH/National Heart, Lung, and Blood Institue (NHLBI).
• Keywords: waiting list; UNITED-STATES; STAGE RENAL-DISEASE; SEX-DIFFERENCES; HEALTH-CARE; Surgery; ACCESS; Science & Technology; kidney transplant; RACIAL DISPARITIES; INSURANCE TYPE; SOCIAL NETWORKS; Transplantation; EVALUATION PROGRAM KEEP; Life Sciences & Biomedicine; OUTCOMES
• Research Categories: Engineering, Biomedical; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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.