Quantifying the risk of incompatible kidney transplantation: a multicenter study.
نویسندگان
چکیده
Incompatible live donor kidney transplantation (ILDKT) offers a survival advantage over dialysis to patients with anti-HLA donor-specific antibody (DSA). Program-specific reports (PSRs) fail to account for ILDKT, placing this practice at regulatory risk. We collected DSA data, categorized as positive Luminex, negative flow crossmatch (PLNF) (n = 185), positive flow, negative cytotoxic crossmatch (PFNC) (n = 536) or positive cytotoxic crossmatch (PCC) (n = 304), from 22 centers. We tested associations between DSA, graft loss and mortality after adjusting for PSR model factors, using 9669 compatible patients as a comparison. PLNF patients had similar graft loss; however, PFNC (adjusted hazard ratio [aHR] = 1.64, 95% confidence interval [CI]: 1.15-2.23, p = 0.007) and PCC (aHR = 5.01, 95% CI: 3.71-6.77, p < 0.001) were associated with increased graft loss in the first year. PLNF patients had similar mortality; however, PFNC (aHR = 2.04; 95% CI: 1.28-3.26; p = 0.003) and PCC (aHR = 4.59; 95% CI: 2.98-7.07; p < 0.001) were associated with increased mortality. We simulated Centers for Medicare & Medicaid Services flagging to examine ILDKT's effect on the risk of being flagged. Compared to equal-quality centers performing no ILDKT, centers performing 5%, 10% or 20% PFNC had a 1.19-, 1.33- and 1.73-fold higher odds of being flagged. Centers performing 5%, 10% or 20% PCC had a 2.22-, 4.09- and 10.72-fold higher odds. Failure to account for ILDKT's increased risk places centers providing this life-saving treatment in jeopardy of regulatory intervention.
منابع مشابه
Assessment of Risk Factors for Hospital Readmission after Kidney Transplantation
Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergo...
متن کاملIncidence and risk factors for cytomegalovirus in kidney transplant patients in Babol, northern Iran
Background: Cytomegalovirus (CMV) disease is an important cause of death and possibly transplant rejection in kidney transplant (KT) patients. This study was conducted to investigate the incidence and risk factors of CMV disease in kidney transplant patients. Methods: All end-stage renal disease (ESRD) patients who underwent kidney transplantation during 1998-2014 and their donors were assessed...
متن کاملClinical outcomes of ABO-incompatible kidney transplant with rituximab and double-filtration plasmapheresis.
OBJECTIVES The best treatment for end-stage renal disease is kidney transplant, but the shortage of donor organs has caused long waiting times for an appropriate organ allograft. The use of ABO-incompatible kidney transplant can be a valuable option to expand the donor pool. The purpose of the present study was to evaluate 13 patients who had successful ABO-incompatible kidney transplant with d...
متن کاملپیشبینی و تعیین عوامل مؤثر بر بقای پنج‌سالۀ کلیۀ پیوندی در داده‌های نامتوازن با رویکرد فراابتکاری و یادگیری ماشین
Chronic kidney failure is one of the most widespread diseases in Iran and the world. In general, the disease is common in high health indexes societies due to increased longevity. Treatment for chronic kidney failure is dialysis and kidney transplantation. Kidney transplantation is an appropriate and effective strategy for patients with End-Stage Renal Disease (ESRD), and it provides a better l...
متن کاملPediatric kidney transplantation: An overview
Kidney Transplantation in children is the treatment of choice to treat end stage renal disease. Improvements in immunosuppressive management have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Reducing of side effects are the challenges for impr...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
دوره 14 7 شماره
صفحات -
تاریخ انتشار 2014