Center-level Variation in HLA-incompatible Living Donor Kidney Transplantation Outcomes
| Autor: | Francis L. Weng, Jacqueline Garonzik-Wang, Matthew Cooper, Jane Long, Eliot Heher, Stanley C. Jordan, Jennifer D. Motter, George S. Lipkowitz, Michael A. Rees, John P. Roberts, Jennifer Verbesey, Pooja Singh, Sandip Kapur, Lloyd E. Ratner, Jennifer K. Chen, David A. Gerber, Tomasz Kozlowski, Mark D. Stegall, Madeleine M. Waldram, Bashir R. Sankari, Niraj M. Desai, Dorry L. Segev, A. Osama Gaber, Jose Oberholzer, Babak J. Orandi, Jose M. El-Amm, Jason R. Wellen, Debra L. Sudan, Adel Bozorgzadeh, R. Pelletier, Enrico Benedetti, Robert A. Montgomery, Mary G. Bowring, Kenneth L. Brayman, Kyle R. Jackson, Marc P. Posner, Beatrice P. Concepcion, J. Harold Helderman, Allan B. Massie, Ty B. Dunn, Christopher L. Marsh, Marc L. Melcher, Karina Covarrubias, Arjang Djamali, Ron Shapiro |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Time Factors Human leukocyte antigen 030230 surgery Risk Assessment Living donor Article 03 medical and health sciences 0302 clinical medicine Highly sensitized HLA Antigens Isoantibodies Risk Factors Internal medicine Living Donors medicine Humans Registries Healthcare Disparities Practice Patterns Physicians' Kidney transplantation Quality Indicators Health Care Transplantation business.industry Proportional hazards model Graft Survival Hazard ratio Middle Aged medicine.disease Kidney Transplantation United States Treatment Outcome Histocompatibility Cohort Female 030211 gastroenterology & hepatology business Immunosuppressive Agents |
| Zdroj: | Transplantation |
| ISSN: | 0041-1337 |
| Popis: | BACKGROUND Desensitization protocols for HLA-incompatible living donor kidney transplantation (ILDKT) vary across centers. The impact of these, as well as other practice variations, on ILDKT outcomes remains unknown. METHODS We sought to quantify center-level variation in mortality and graft loss following ILDKT using a 25-center cohort of 1358 ILDKT recipients with linkage to Scientific Registry of Transplant Recipients for accurate outcome ascertainment. We used multilevel Cox regression with shared frailty to determine the variation in post-ILDKT outcomes attributable to between-center differences and to identify any center-level characteristics associated with improved post-ILDKT outcomes. RESULTS After adjusting for patient-level characteristics, only 6 centers (24%) had lower mortality and 1 (4%) had higher mortality than average. Similarly, only 5 centers (20%) had higher graft loss and 2 had lower graft loss than average. Only 4.7% of the differences in mortality (P < 0.01) and 4.4% of the differences in graft loss (P < 0.01) were attributable to between-center variation. These translated to a median hazard ratio of 1.36 for mortality and 1.34 of graft loss for similar candidates at different centers. Post-ILDKT outcomes were not associated with the following center-level characteristics: ILDKT volume and transplanting a higher proportion of highly sensitized, prior transplant, preemptive, or minority candidates. CONCLUSIONS Unlike most aspects of transplantation in which center-level variation and volume impact outcomes, we did not find substantial evidence for this in ILDKT. Our findings support the continued practice of ILDKT across these diverse centers. |
| Databáze: | OpenAIRE |
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