Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival.
S Ali Husain, Kristen L King, Geoffrey K Dube and 4 others
PMID 31506000WHAT IT FOUND
Kidney transplant candidates with the best expected survival did not have equal access to the best expected-quality deceased donor kidneys across United States regions; region 6 had the most, region 9 the least.
Key findings
01Of 34 562 candidates listed with EPTS <= 20%, 4251 (12.3%) lost that status by the end of follow-up.
02The odds of receiving a KDPI <= 20% kidney were lowest in region 9 compared with region 6, with an odds ratio of 0.19 (95% confidence interval: 0.13-0.28).
03Nearly half (48%) of KDPI <= 20% kidneys were transplanted into recipients with EPTS > 20% at transplant, and 66% of those kidneys were used in multi-organ transplants.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is registry data, not a randomised trial or intervention study, so it can show patterns in organ receipt but cannot prove that moving a candidate to a region or changing allocation causes better outcomes. The study did not include match-run data, so it could not compare how many organ offers were made or declined for candidates with EPTS <= 20% versus EPTS > 20%. Follow-up was short after the new allocation system, and most candidates were not transplanted, so longer-term access differences are unknown. The EPTS <= 20% and KDPI <= 20% cut-points are policy dichotomies, not clinically sharp boundaries.
Declared interests
The authors declared no potential conflicts of interest. The publication types list research support from N.I.H., U.S. government, and non-U.S. government sources.
The easy way to misread this
Do not conclude that transplantation in region 6 causes better kidney quality or survival. The odds ratio 0.19 for region 9 versus region 6 is an association from registry data, and the study did not test moving candidates or changing allocation.