Living Kidney Donor Follow-Up: State-of-the-Art and Future Directions, Conference Summary and Recommendations

Leichtman, Alan B.; Abecassis, Michael; Barr, Mark L.; Charlton, Marian; Cohen, David J.; Confer, Dennis L.; Cooper, Mathew; Danovitch, Gabriel M.; Davis, Connie L.; Delmonico, Francis L.; Dew, Mary Amanda; Garvey, Cathy; Gaston, Robert S.; Gill, John S.; Gillespie, Brenda W.; Ibrahim, Hassan N.; Jacobs, Cheryl; Kahn, Jeffrey; Kasiske, B. L.; Kim, Joseph; Lentine, Krista L.; Manyalich, M.; Medina-Pestana, J.O.; Merion, Robert M.; Moxey-Mims, Marva; Odim, Jonah; Opelz, G; Orlowski, Janice; Rizvi, Abid; Roberts, John P.; Segev, Dorry L.; Sledge, Tina; Steiner, Robert W.; Taler, Sandra J.; Textor, S. C.; Thiel, G; Waterman, Amy D.; Williams, Errol; Wolfe, Robert A.; Wynn, James J.; Matas, Arthur J.

doi:10.1111/j.1600-6143.2011.03816.x

Cited by 91 publications

(30 citation statements)

References 36 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our DID model showed a pre-policy increase in LDF of 20% per year for 6-month and 1-year LDF and 22% per year for 2-year LDF. These pre-policy increases in LDF may be attributable to the public comment process and consensus conferences (39). Despite increases in LDF, only 43% of centers met all the policy requirements for 2013 LKDs.…”

Section: Discussionmentioning

confidence: 99%

The National Landscape of Living Kidney Donor Follow-Up in the United States

Henderson

Thomas

Shaffer

et al. 2017

American Journal of Transplantation

View full text Add to dashboard Cite

In 2013, OPTN/UNOS mandated that transplant centers collect data on living kidney donors (LKDs) at 6-months, 1-year, and 2-years post-donation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied SRTR data for 31,615 LKDs between 1/2010-6/2015, comparing proportions of complete and timely LDF form submissions pre- and post-policy implementation. We also used multilevel logistic regression to assess donor- and center-level characteristics associated with complete and timely LDF submissions. Complete and timely 2-year LDF increased from 33% pre-policy (1/2010-1/2013) to 54% post-policy (2/2013-6/2015) (p<0.001). In an adjusted model, the odds of 2-year LDF increased by 22% per year pre-policy (p<0.001) and 23% per year post-policy (p<0.001). Despite these annual increases in LDF, only 43% (87/202) of centers met the OPTN/UNOS-required 6-month, 1-year, and 2-year LDF thresholds for LKDs who donated in 2013. These findings motivate further evaluation of LDF barriers and the optimal approaches to capturing outcomes after living donation.

show abstract

Section: Discussionmentioning

confidence: 99%

The National Landscape of Living Kidney Donor Follow-Up in the United States

Henderson

Thomas

Shaffer

et al. 2017

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Innovative approaches to capturing outcomes among representative, diverse samples of living donors are needed. Supplementing the national registry with secondary data sources was endorsed by a consensus conference convened to evaluate ‘Living Kidney Donor Follow-Up: State-of-the-Art and Future Directions' [31] and by individual experts in living donor care [32]. Methodologically, the current study demonstrates the value of pharmacy claims to describe an understudied dimension of health after living kidney donation.…”

Section: Discussionmentioning

confidence: 99%

Understanding Antihypertensive Medication Use after Living Kidney Donation through Linked National Registry and Pharmacy Claims Data

et al. 2014

View full text Add to dashboard Cite

Background: Use of antihypertensive medications (AHM) after living kidney donation is not well described. Methods: We examined a database wherein national transplant registry data for 4,650 living kidney donors in 1987-2007 were linked to pharmacy claims from a US private health insurer (2000-2007 claims) to identify post-donation AHM fills. Cox regression with left- and right-censoring was used to estimate the frequencies and relative likelihood (adjusted hazards ratios, aHR) of post-donation AHM fills according to donor demographic traits. Medication possession ratio (MPRs), defined as (days of AHM dispensed)/(days observed), were also compared among donors and non-donor general beneficiaries. Results: Overall, 17.8% of the sample filled at least one AHM by 5 years post-donation. As compared with White living donors, African-Americans had 37% higher relative likelihood of any AHM use after donation (aHR 1.37, p < 0.0007), including significantly higher likelihoods of filling diuretics (aHR 2.25, p < 0.0001), ACEi/ARBs (aHR 1.46, p < 0.01), calcium channel blockers (aHR 1.56, p = 0.03), and vasodilators/other agents (aHR 2.17, p = 0.03). MPRs for any AHM and subcategories were lower among donors compared with age- and sex-matched non-donors. However, AHM MPRs rose in donors with multiple hypertension diagnoses, and prescription fill exposure for all AHM classes except diuretics was similar among donors and general non-donors with ≥3 hypertension diagnoses. Conclusions: While AHM requirements are lower after kidney donation than among unscreened general persons, racial variation in AHM use occurs in privately insured donors. Demonstration of pharmaceutical care needs of insured donors supports the need for long-term follow-up and healthcare access for all donors.

show abstract

“…As a reflection of the need for a better understanding of health outcomes specifically among non-white donors, a recent U.S. national consensus conference was convened to evaluate “Living Kidney Donor Follow-up: State-of-the-Art and Future Direction” (5). At this conference, non-white donors were identified as a leading subgroup deserving focused attention.…”

mentioning

confidence: 99%

“…At this conference, non-white donors were identified as a leading subgroup deserving focused attention. Important postdonation outcomes named as focus areas included not only death and terminal renal failure but also chronic medical conditions that may cause kidney damage or bear bidirectional relationships with renal insufficiency, such as hypertension and diabetes mellitus (5). To that end, we recently linked administrative data from a private insurance provider to OPTN donor registration data and observed that, compared with white donors, African American donors had higher risks of postdonation morbidity (6).…”

mentioning

confidence: 99%

Consistency of Racial Variation in Medical Outcomes Among Publicly and Privately Insured Living Kidney Donors

et al. 2014

View full text Add to dashboard Cite

Background Racial disparities in health outcomes after living donation have been reported, but generalizability is not known. Methods We linked Organ Procurement and Transplantation Network (OPTN) registry data for 4,007 living kidney donors in 1987 to 2008 with Medicare billing claims (2000–2008). Cox regression with left and right censoring was used to estimate the frequencies and relative risks of postdonation medical diagnoses according to race. Patterns were compared with findings from a previous linkage of OPTN donor records and private insurance claims. Results Among the Medicare-insured donors, 8% were African American and 5.7% were Hispanic. Diagnosis frequencies at 5 years after donation in the Medicare-versus privately insured donors included the following: malignant hypertension, 5.0% versus 0.9%; diabetes, 18.5% versus 4.1%; and chronic kidney disease, 21.8% versus 4.9%. After age and sex adjustment in the Medicare sample, African Americans, as compared with white donors, experienced higher risks of any hypertension diagnosis, including 2.4 times the likelihood of malignant hypertension (adjusted hazard ratio [aHR], 2.35; 95% confidence interval [CI], 1.40–3.93), and more common diabetes (aHR, 1.50; 95% CI, 1.12–2.04), chronic kidney disease (aHR, 1.84; 95% CI, 1.37–2.47), and proteinuria (aHR, 2.44; 95% CI, 1.45–4.11) diagnoses. Relative patterns for privately insured African American versus white donors were similar, including approximately three times the risk of malignant hypertension (aHR, 3.27; 95% CI, 1.82–5.88) and twice the relative risks of chronic kidney disease and proteinuria. Conclusions Consistent demonstration of racial variation in postdonation medical conditions regardless of sample/payer source supports the need for continued study of mediators and consequences of outcomes in non-white donors.

show abstract

Living Kidney Donor Follow-Up: State-of-the-Art and Future Directions, Conference Summary and Recommendations

Cited by 91 publications

References 36 publications

The National Landscape of Living Kidney Donor Follow-Up in the United States

The National Landscape of Living Kidney Donor Follow-Up in the United States

Understanding Antihypertensive Medication Use after Living Kidney Donation through Linked National Registry and Pharmacy Claims Data

Consistency of Racial Variation in Medical Outcomes Among Publicly and Privately Insured Living Kidney Donors

Contact Info

Product

Resources

About