Deceased donor kidney transplantation (DDKT) rates for highly sensitized (HS) candidates increased early after implementation of the Kidney Allocation System (KAS) in 2014. However, this may represent a bolus effect, and a granular investigation of the current state of DDKT for HS candidates remains lacking. We studied 270 722 DDKT candidates from the SRTR from 12/4/2011 to 12/3/2014 (“pre‐KAS”) and 12/4/2014 to 12/3/2017 (“post‐KAS”), analyzing DDKT rates for HS candidates using adjusted negative binomial regression. Post‐KAS, candidates with the highest levels of sensitization had an increased DDKT rate compared with pre‐KAS (cPRA 98% adjusted incidence rate ratio [aIRR]:1.271.772.46 P = .001, cPRA 99% aIRR:3.184.365.98 P < .001, cPRA 99.5–99.9% aIRR:16.9124.2934.89 P < .001, and cPRA 99.9%+ aIRR:8.7911.5815.26 P < .001). To determine whether these changes produced more equitable access to DDKT, we compared DDKT rates of HS to non‐HS candidates (cPRA 0–79%). Post‐KAS, cPRA, 98% candidates had an equivalent DDKT rate (aIRR:0.650.941.36, P = .8) to non‐HS candidates, whereas 99% candidates had a higher DDKT rate (aIRR:1.191.682.38, P = .02). Although cPRA 99.5–99.9% candidates had an increased DDKT rate (aIRR:2.463.504.98, P < .001) compared to non‐HS candidates, cPRA 99.9%+ candidates had a significantly lower DDKT rate (aIRR:0.290.400.56, P < .001). KAS has improved access to DDKT for HS candidates, although substantial imbalance exists between cPRA 99.5–99.9% and 99.9%+ candidates.
One criticism of kidney paired donation (KPD) is that easy-to-match candidates leave the registry quickly, thus concentrating the pool with hard-to-match sensitized and blood type O candidates. We studied candidate/donor pairs who registered with the National Kidney Registry (NKR), the largest US KPD clearinghouse, from January 2012-June 2016. There were no changes in age, gender, BMI, race, ABO blood type, or panel-reactive antibody (PRA) of newly registering candidates over time, with consistent registration of hard-to-match candidates (59% type O and 38% PRA ≥97%). However, there was no accumulation of type O candidates over time, presumably due to increasing numbers of nondirected type O donors. Although there was an initial accumulation of candidates with PRA ≥97% (from 33% of the pool in 2012% to 43% in 2014, P = .03), the proportion decreased to 17% by June 2016 (P < .001). Some of this is explained by an increase in the proportion of candidates with PRA ≥97% who underwent a deceased donor kidney transplantation (DDKT) after the implementation of the Kidney Allocation System (KAS), from 8% of 2012 registrants to 17% of 2015 registrants (P = .02). In this large KPD clearinghouse, increasing participation of nondirected donors and the KAS have lessened the accumulation of hard-to-match candidates, but highly sensitized candidates remain hard-to-match.
Background:We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. Methods:We identified 2726 infants (≤24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. Results:In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio: 1.46 1.59 1.70 ; non-ICU ratio: 1.08 1.16 1.23 ), public insurance (ratio: 1.03 1.09 1.15 ), and a segmental graft (ratio: 1.08 1.15 1.22 ) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio: 1.49 1.62 1.77 ; non-ICU ratio: 1.34 1.44 1.56 ), public insurance (ratio: 1.02 1.07 1.13 ), a segmental graft (ratio: 1.20 1.27 1.35 ), a living donor graft (ratio: 1.27 1.38 1.51 ), and obesity (ratio: 1.03 1.10 1.17 ) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. Conclusions:While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates. K E Y W O R D S length of stay, liver transplantation, MELD, pediatric, PELD Approximately 600 children with ESLD will undergo liver transplantation annually in the United States, with priority given to the sickest candidates as determined by the PELD/MELD score. 1 Understanding hospital LOS is necessary to provide more personalized counseling and discharge planning for pediatric liver transplant recipients and their families. 2 From a more practical perspective, understanding LOS is important for families when considering how duration of hospitalization will affect other aspects of their lives, such as arranging childcare for siblings, requesting time off work, and coordinating travel between the transplant center and the patient's home. 3 Most importantly, a prolonged hospitalization places pediatric liver transplant recipient at risk for developing hospital-acquired infections.Finally, from a financial perspective, a longer LOS incurs more costs; a longer LOS in adult liver transplant recipients has been tied to increasing costs and resource utilization. 4A previous multi-center study from the pre-PELD/MELD era of pediatric liver transplantation found that recipients...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.