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Center-level Variation in HLA-incompatible Living Donor Kidney Transplantation Outcomes
- Source :
- Transplantation
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- 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.
- Subjects :
- 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
Subjects
Details
- ISSN :
- 00411337
- Volume :
- 105
- Database :
- OpenAIRE
- Journal :
- Transplantation
- Accession number :
- edsair.doi.dedup.....a88c0b3790f30c5811c1eaaf3de763be