TY - JOUR
T1 - Duration of Living Kidney Transplant Donor Evaluations
T2 - Findings From 2 Multicenter Cohort Studies
AU - Donor Nephrectomy Outcomes Research (DONOR) Network
AU - Habbous, Steven
AU - Arnold, Jennifer
AU - Begen, Mehmet A.
AU - Boudville, Neil
AU - Cooper, Matthew
AU - Dipchand, Christine
AU - Dixon, Stephanie N.
AU - Feldman, Liane S.
AU - Goździk, Dariusz
AU - Karpinski, Martin
AU - Klarenbach, Scott
AU - Knoll, Greg A.
AU - Lam, Ngan N.
AU - Lentine, Krista L.
AU - Lok, Charmaine
AU - McArthur, Eric
AU - McKenzie, Susan
AU - Miller, Matthew
AU - Monroy-Cuadros, Mauricio
AU - Nguan, Chris
AU - Prasad, G. V.Ramesh
AU - Przech, Sebastian
AU - Sarma, Sisira
AU - Segev, Dorry L.
AU - Storsley, Leroy
AU - Garg, Amit X.
AU - Nguan, Chris
AU - Monroy-Cuadros, Mauricio
AU - Klarenbach, Scott
AU - Lam, Ngan N.
AU - Storsley, Leroy
AU - Karpinski, Martin
AU - Garg, Amit X.
AU - Treleavan, Darin
AU - Miller, Matthew
AU - Kim, Joseph
AU - Lok, Charmine
AU - Prasad, G. V.Ramesh
AU - Knoll, Greg
AU - Bugeja, Ann
AU - Feldman, Liane S.
AU - Dipchand, Christine
AU - Young, Ann
AU - Arnold, Jennifer
AU - Goździk, Dariusz
AU - Sontrop, Jessica
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. Study Design: 1 prospective and 1 retrospective cohort study. Setting & Participants: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times. Data were obtained from 2 sources: donor medical records using chart abstraction and health care administrative databases. Predictors: Donor and recipient demographics, direct versus paired donation, center-level variables. Outcomes: Duration of living donor evaluation. Results: The median total duration of transplantation evaluation (time from when the candidate started the evaluation until donation) was 10.3 (IQR, 6.5-16.7) months. The median duration from evaluation start until approval to donate was 7.9 (IQR, 4.6-14.1) months, and from approval until donation was 0.7 (IQR, 0.3-2.4) months, respectively. The median time between the first and last consultation among donors who completed a nephrology, surgery, and psychosocial assessment in the prospective cohort was 3.0 (IQR, 1.0-6.3) months, and between computed tomography angiography and donation was 4.8 (IQR, 2.6-9.2) months. After adjustment, the total duration of transplantation evaluation was longer if the donor participated in paired donation (6.6 [95% CI, 1.6-9.7] months) and if the recipient was referred later relative to the donor's evaluation start date (0.9 [95% CI, 0.8-1.0] months [per month of delayed referral]). Results depended on whether the recipient was receiving dialysis. Limitations: Living donor candidates who did not donate were not included and proxy measures were used for some dates in the donor evaluation process. Conclusions: The duration of kidney transplant donor evaluation is variable and can be lengthy. Better understanding of the reasons for a prolonged evaluation may inform quality improvement initiatives to reduce unnecessary delays.
AB - Background: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. Study Design: 1 prospective and 1 retrospective cohort study. Setting & Participants: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times. Data were obtained from 2 sources: donor medical records using chart abstraction and health care administrative databases. Predictors: Donor and recipient demographics, direct versus paired donation, center-level variables. Outcomes: Duration of living donor evaluation. Results: The median total duration of transplantation evaluation (time from when the candidate started the evaluation until donation) was 10.3 (IQR, 6.5-16.7) months. The median duration from evaluation start until approval to donate was 7.9 (IQR, 4.6-14.1) months, and from approval until donation was 0.7 (IQR, 0.3-2.4) months, respectively. The median time between the first and last consultation among donors who completed a nephrology, surgery, and psychosocial assessment in the prospective cohort was 3.0 (IQR, 1.0-6.3) months, and between computed tomography angiography and donation was 4.8 (IQR, 2.6-9.2) months. After adjustment, the total duration of transplantation evaluation was longer if the donor participated in paired donation (6.6 [95% CI, 1.6-9.7] months) and if the recipient was referred later relative to the donor's evaluation start date (0.9 [95% CI, 0.8-1.0] months [per month of delayed referral]). Results depended on whether the recipient was receiving dialysis. Limitations: Living donor candidates who did not donate were not included and proxy measures were used for some dates in the donor evaluation process. Conclusions: The duration of kidney transplant donor evaluation is variable and can be lengthy. Better understanding of the reasons for a prolonged evaluation may inform quality improvement initiatives to reduce unnecessary delays.
KW - end-stage kidney disease
KW - evaluation time
KW - living donor evaluation
KW - Living kidney donation
KW - pre-emptive kidney transplant
KW - quality indicators
KW - recipient referral
UR - http://www.scopus.com/inward/record.url?scp=85044327153&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2018.01.036
DO - 10.1053/j.ajkd.2018.01.036
M3 - Article
C2 - 29580662
AN - SCOPUS:85044327153
SN - 0272-6386
VL - 72
SP - 483
EP - 498
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -