Premium
Critical Factors Associated With Missing Follow‐Up Data for Living Kidney Donors in the United States
Author(s) -
Schold J. D.,
Buccini L. D.,
Rodrigue J. R.,
Mandelbrot D.,
Goldfarb D. A.,
Flechner S. M.,
Kayler L. K.,
Poggio E. D.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13282
Subject(s) - medicine , logistic regression , odds ratio , demography , single center , odds , confidence interval , kidney transplantation , transplantation , sociology
Follow‐up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow‐up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow‐up information by centers for 2 years. We utilized national SRTR data to evaluate donor and center‐level factors associated with completed follow‐up for donors 2008–2012 (n = 30 026) using multivariable hierarchical logistic models. We compared center follow‐up compliance based on current UNOS standards using adjusted and unadjusted models. Complete follow‐up at 6, 12, and 24 months was 67%, 60%, and 50% for clinical and 51%, 40%, and 30% for laboratory data, respectively, but have improved over time. Donor risk factors for missing laboratory data included younger age 18–34 (adjusted odds ratio [AOR] = 2.03, 1.58–2.60), black race (AOR = 1.17, 1.05–1.30), lack of insurance (AOR = 1.25, 1.15–1.36), lower educational attainment (AOR = 1.19, 1.06–1.34), >500 miles to center (AOR = 1.78, 1.60–1.98), and centers performing >40 living donor transplants/year (AOR = 2.20, 1.21–3.98). Risk‐adjustment moderately shifted classification of center compliance with UNOS standards. There is substantial missing donor follow‐up with marked variation by donor characteristics and centers. Although follow‐up has improved over time, targeted efforts are needed for donors with selected characteristics and at centers with higher living donor volume. Adding adjustment for donor factors to policies regulating follow‐up may function to provide more balanced evaluation of center efforts.