Kidney transplant program waitlisting rate as a metric to assess transplant access

• Type of Material: Article
• Authors: Sudeshna Paul, Emory University; Taylor Melanson, Emory University; Sumit Mohan, Vagelos College of Physicians & Surgeons; Katherine Ross-Driscoll, Emory University; Laura McPherson, Emory University; Raymond Lynch, Emory University; Denise Lo, Emory University; Stephen Pastan, Emory University; Rachel Patzer, Emory University
• Language: English
• Date: 2020-09-15
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved. Published by Elsevier B.V. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.16277
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 21
• Issue: 1
• Start Page: 314
• End Page: 321
• Grant/Funding Information: National Institute on Minority Health and Health Disparities, Grant/Award Number: U01MD010611
• Keywords: DIALYSIS FACILITY; Life Sciences & Biomedicine; ASSOCIATION; Science & Technology; Surgery; Transplantation; STAGE RENAL-DISEASE

Abstract

Kidney transplant program performance in the United States is commonly measured by posttransplant outcomes. Inclusion of pretransplant measures could provide a more comprehensive assessment of transplant program performance and necessary information for patient decision-making. In this study, we propose a new metric, the waitlisting rate, defined as the ratio of patients who are waitlisted in a center relative to the person-years referred for evaluation to a program. Furthermore, we standardize the waitlisting rate relative to the state average in Georgia, North Carolina, and South Carolina. The new metric was used as a proof-of-concept to assess transplant-program access compared to the existing transplant rate metric. The study cohorts were defined by linking 2017 United States Renal Data System (USRDS) data with transplant-program referral data from the Southeastern United States between January 1, 2012 and December 31, 2016. Waitlisting rate varied across the 9 Southeastern transplant programs, ranging from 10 to 22 events per 100 patient-years, whereas the program-specific waitlisting rate ratio ranged between 0.76 and 1.33. Program-specific waitlisting rate ratio was uncorrelated with the transplant rate ratio (r = −.15, 95% CI, −0.83 to 0.57). Findings warrant collection of national data on early transplant steps, such as referral, for a more comprehensive assessment of transplant program performance and pretransplant access.