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11. Economics

Author

Schnitzler, M.A., Valapour, M., Skeans, M.A., Axelrod, D.A., Lentine, K.L., Randall, H.B., Snyder, J.J., Israni, A.K., and Kasiske, B.L.

Published
2016
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12. Lung

Author

Valapour, M., Skeans, M.A., Smith, J.M., Edwards, L.B., Cherikh, W.S., Callahan, E.R., Israni, A.K., Snyder, J.J., and Kasiske, B.L.

Published
2016
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35. OPTN/SRTR2018 Annual Data Report: Lung

Author

Valapour, M., Lehr, C. J., Skeans, M. A., Smith, J. M., Uccellini, K., Goff, R., Foutz, J., Israni, A. K., Snyder, J. J., and Kasiske, B. L.

Abstract

The primary goal of USlung allocation policy is to ensure that candidates with the highest risk for mortality receive appropriate access to lung transplant. In 2018, 2562 lung transplants were performed in the US, reflecting a 31% increase over the past 5 years. More candidates are being listed for lung transplant, and the number of donors has increased substantially. Despite an increase of 84 lung transplants in 2018, 365 adult candidates died or became too sick to undergo transplant. In 2018, 24 new child (ages 0‐11 years) candidates were added to the lung transplant waiting list. Fifteen lung transplants were performed in recipients aged 0‐11 years, three in recipients aged younger than 1 year, two in recipients aged 1‐5 years, and ten in recipients aged 6‐11 years. Of 27 child candidates removed from the waiting list in 2018, 16 (59.3%) were removed due to undergoing transplant, six (22.2%) due to death, one (3.7%) due to improved condition, and one (3.7%) due to becoming too sick to undergo transplant.

Published
2020
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37. Assessing elements of informed consent among living donors

Author

Valapour, M, Kahn, JP, Bailey, R, and Matas, AJ

Subjects
Informed Consent, Living Donors, Quality of Life, Humans, Family, Attitude to Health, Kidney Transplantation, Article, United States, Retrospective Studies
Abstract

Living organ donors - 50% of solid organ donors in the United States - represent a unique population who accept medical risk for the benefit of another. One of the main justifications for this practice has been respect for donor autonomy, as realized through informed consent. In this retrospective study of living donors, we investigate two key criteria of informed consent: (i) depth of understanding and (ii) degree of voluntariness. In our survey of 262 living kidney donors 2-40 months post-donation, we found that more than 90% understood the effects of living donation on recipient outcomes, the screening process, and the short-term medical risks of donation. In contrast, only 69% understood the psychological risks of donation; 52% the long-term medical risks of donation; and 32% the financial risks of donation. Understanding the effects of living donation on recipient outcomes was the only factor that would affect donors' decision to donate again. A total of 40% of donors reported feeling some pressure to donate. Donors who are related to the recipient were more likely to report feeling pressure to donate. We conclude that more studies of informed consent are needed to identify factors that may compromise the validity of informed consent.

Published
2010

38. Socioeconomic Position Does Not Account for Racial Disparities in Survival after Lung Transplant.

Author

Lehr, C.J., Valapour, M., Gunsalus, P.R., Rose, J., and Dalton, J.E.

Subjects
*LUNG transplantation, *RACIAL inequality, *RACE, *ETHNIC groups, *ZIP codes
Abstract

To study the extent that donor and recipient racial differences in survival after lung transplant (LT) is mediated by socioeconomic position (SEP) and region. 19504 LT recipients and donors from 9/2011-9/2021 were identified from the US Scientific Registry of Transplant Recipients (SRTR) and matched to University of Wisconsin Area Deprivation Index (ADI) values by ZIP code tabulation area. Variation in post-transplant mortality rates across racial and/or ethnic groups, ADI quintiles, and U.S. Census regions were studied using Kaplan-Meier (KM) analysis and Cox proportional hazards regression. Bayesian conditional autoregressive (CAR) Poisson rate models were used to estimate standardized mortality ratios by US state. In multivariable analysis, receipt of organs from Non-Hispanic Black (NHB) donors and donors from high-deprivation localities (highest ADI quintile) was associated with a 22% (95% CI[1.14, 1.29]) and an 8% (95% CI [1.00, 1.16]) increased risk of posttransplant (PT) mortality on recipients relative to non-Hispanic white (NHW) donors and donors from high-resource localities (lowest ADI quintile), respectively. NHB recipients experienced a 10% (95% CI[1.02, 1.20]) increased risk of PT mortality (vs. NHW), without differences by ADI. KM survival was lower for LT recipients who received an organ from donors residing in highest ADI (least resourced areas). CAR models demonstrated regional effects but these effects were not distinct from those relating to race, ethnicity and ADI (Figure). Noted differences in PT survival among racial and ethnic groups could not be fully accounted for by neighborhood SEP and region, a strong predictor of outcomes in other populations. This may be due to the highly selected nature of transplant candidates. Further research should focus on additional mediators beyond those captured in ADI. Funding: NIH K08HL159236, R01HL153175 [ABSTRACT FROM AUTHOR]

Published
2023
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42. OPTN/SRTR2016 Annual Data Report: Lung

Author

Valapour, M., Lehr, C. J., Skeans, M. A., Smith, J. M., Carrico, R., Uccellini, K., Lehman, R., Robinson, A., Israni, A. K., Snyder, J. J., and Kasiske, B. L.

Abstract

In 2016, 2692 candidates aged 12 years or older were added to the lung transplant waiting list; 2345 transplants were performed, the largest number of any prior year. The median waiting time for listed candidates in 2016 was 2.5 months, and waiting times were shortest for group D candidates. The transplant rate increased to 191.9 transplants per 100 waitlist years in 2016, with a slight decrease in waitlist mortality to 15.1 deaths per 100 waitlist years. Short‐term survival continued to improve, with a 6‐month death rate of 6.6% and a 1‐year death rate of 10.8% among recipients in 2015 compared with 8.0% and 13.3%, respectively, among recipients in 2014. Long‐term survival rates remained unchanged; 55.6% of recipients were alive at 5 years. In 2016, 23 new candidates aged 0‐11 years were added to the waiting list and 16 lung transplants were performed. Incidence of posttransplant mortality for lung transplant recipients aged 0‐11 years who underwent transplant in 2014‐2015 was 13.8% at 6 months and 19.6% at 1 year. Changes in waitlist and transplant demographic features continued to evolve following implementation of the revised lung allocation score in 2015. Some early trends that may be attributable to the revised LASare shorter waiting times, stabilization of the number of group D candidates listed for transplant, and convergence of LASwith lower prevalence of extremely high scores.

Published
2018
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