Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States
F. P. Sanfilippo, W. K. Vaughn, T. G. Peters, C. F. Shield 3rd, P. L. Adams, M. I. Lorber and G. M. Williams
Department of Pathology, Duke University, Durham, NC.
OBJECTIVE--To evaluate the relative impact of various factors that could
account for differences in waiting time of cadaveric kidney transplant
candidates (eg, black and sensitized patients). DESIGN.--A cohort study
using multivariate analyses to identify associations between 36 patient,
donor, and center factors with waiting time for all US cadaveric kidney
transplant candidates listed between October 1, 1987, and June 30, 1990.
SETTING--All US kidney transplant centers. PATIENTS--The study included
23,468 cadaveric renal transplant candidates on active waiting status.
RESULTS--The patient characteristics most significantly associated with
increased waiting time (adjusted for all other variables) were immunologic
and included presensitization to HLA antigens, O or B blood type, candidacy
for a repeat transplantation, and expression of rare HLA-A or HLA-B antigen
phenotypes. Nonimmunologic factors also affected waiting times, which were
significantly shorter for patients younger than 15 years vs those aged 15
through 44 years (8.4 vs 12.9 months, respectively; P less than .0001), for
those listed at multiple centers vs one center (7.0 vs 13.3 months,
respectively; P less than .0001), or for white vs black patients (11.9 vs
15.4 months, respectively; P less than .0001). Local transplant center
characteristics associated with a significantly shorter waiting time
included a small number of transplantation candidates, a high (greater than
35 per million population) local kidney organ recovery rate, and an
approved variance from the Organ Procurement and Transplantation Network
allocation algorithm. CONCLUSIONS--The time renal transplant candidates
must wait for kidney transplantation is influenced by several factors in
addition to those expected due to immunologic reasons of donor
incompatibility, the algorithms used for organ distribution, or the
effectiveness of local kidney recovery. The impact of these factors should
be considered as the current US system for allocating scarce donor organs
for kidney transplantation is modified.
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