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Substantial Variation in the Acceptance of Medically Complex Live Kidney Donors Across US Renal Transplant Centers
Author(s) -
Reese P. P.,
Feldman H. I.,
McBride M. A.,
Anderson K.,
Asch D. A.,
Bloom R. D.
Publication year - 2008
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/j.1600-6143.2008.02361.x
Subject(s) - medicine , kidney transplantation , renal function , multivariate analysis , kidney , cohort , donation , kidney disease , urology , economics , economic growth
Concern exists about accepting live kidney donation from ‘medically complex donors’—those with risk factors for future kidney disease. This study's aim was to examine variation in complex kidney donor use across US transplant centers. We conducted a retrospective cohort study of live kidney donors using organ procurement and transplantation network data. Donors with hypertension, obesity or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 were considered medically complex. Among 9319 donors, 2254 (24.2%) were complex: 1194 (12.8%) were obese, 956 (10.3%) hypertensive and 392 (4.2%) had low eGFR. The mean proportion of medically complex donors at a center was 24% (range 0–65%). In multivariate analysis, donor characteristics associated with medical complexity included spousal relationship to the recipient (OR 1.29, CI 1.06–1.56, p < 0.01), low education (OR 1.19, CI 1.04–1.37, p = 0.01), older age (OR 1.01 per year, CI 1.01–1.02, p < 0.01) and non‐US citizenship (OR 0.70, CI 0.51–0.97, p = 0.03). Renal transplant centers with the highest transplant volume (OR 1.26, CI 1.02–1.57, p = 0.03), and with a higher proportion of (living donation)/(all kidney transplants) (OR 1.97, CI 1.23–3.16, p < 0.01) were more likely to use medically complex donors. Though controversial, the use of medically complex donors is widespread and varies widely across centers.