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Yu M, King KL, Maclay LM, Husain SA, Schold JD, Mohan S. Incomplete reporting of clinically significant acute rejection episodes in the national kidney transplant registry. Am J Transplant 2024:S1600-6135(24)00277-6. [PMID: 38636806 DOI: 10.1016/j.ajt.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Administrative claims data could provide a unique opportunity to identify acute rejection (AR) events using specific antirejection medications and to validate rejected data reported to the Organ Procurement and Transplantation Network. This retrospective cohort study examined differences in registry-reported events and those identified using claims data among adult kidney transplant recipients from 2012 to 2017 using Standard Analysis Files from the US Renal Data System. Rejection rates, survival estimates, and center-level differences were assessed using each approach. Among 45 880 first-time kidney transplant recipients, we identified 3841 AR events within 12 months of transplant reported by centers in the registry; claims data yielded 2945 events. Of all events occurring within 12 months of transplant, 48.5% were reported using registry only, 32.9% were identified using claims only, and 18.6% were identified using both approaches. A 3-year death-censored graft survival probability was 90.0%, 88.4%, and 81.2% (P < .001) for ARs identified using registry only, claims data only, and both approaches, respectively. The large discordance between registry-reported and claims-based events suggests incomplete and potentially inaccurate reporting of events in the Organ Procurement Transplant Network registry. These findings have important implications for analyses that use AR data and underscore the need for improved capture of clinically meaningful events.
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Affiliation(s)
- Miko Yu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Kristen L King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Lindsey M Maclay
- Columbia University Renal Epidemiology Group, New York, New York, USA
| | - S Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
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2
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McElroy LM, Mohottige D, Cooper A, Sanoff S, Davis LA, Collins BH, Gordon EJ, Wang V, Boulware LE. Improving Health Equity in Living Donor Kidney Transplant: Application of an Implementation Science Framework. Transplant Proc 2024; 56:68-74. [PMID: 38184377 DOI: 10.1016/j.transproceed.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Interventions to improve racial equity in access to living donor kidney transplants (LDKT) have focused primarily on patients, ignoring the contributions of clinicians, transplant centers, and health system factors. Obtaining access to LDKT is a complex, multi-step process involving patients, their families, clinicians, and health system functions. An implementation science framework can help elucidate multi-level barriers to achieving racial equity in LDKT and guide the implementation of interventions targeted at all levels. METHODS We adopted the Pragmatic Robust Implementation and Sustainability Model (PRISM), an implementation science framework for racial equity in LDKT. The purpose was to provide a guide for assessment, inform intervention design, and support planning for the implementation of interventions. RESULTS We applied 4 main PRISM domains to racial equity in LDKT: Organizational Characteristics, Program Components, External Environment, and Patient Characteristics. We specified elements within each domain that consider perspectives of the health system, transplant center, clinical staff, and patients. CONCLUSION The applied PRISM framework provides a foundation for the examination of multi-level influences across the entirety of LDKT care. Researchers, quality improvement staff, and clinicians can use the applied PRISM framework to guide the assessment of inequities, support collaborative intervention development, monitor intervention implementation, and inform resource allocation to improve equity in access to LDKT.
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Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina.
| | | | - Alexandra Cooper
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Scott Sanoff
- Department of Medicine, Duke University, Durham, North Carolina
| | - LaShara A Davis
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | | | - Elisa J Gordon
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Virginia Wang
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
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Baroux N, Gilles DDS, Lamy T, Biche V, Wyburn K, Quirin N. Risk factors for loss to follow-up and outcomes after kidney donation in New Caledonian living donors. Nephrology (Carlton) 2023; 28:187-195. [PMID: 36645316 DOI: 10.1111/nep.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/17/2023]
Abstract
AIM For patients with end-stage kidney disease, living-donor kidney transplantation is the best therapy. There is a duty to ensure that the donor is followed-up after donation on a regular and long-term basis. Conditions may arise, such as hypertension, chronic kidney disease, metabolic conditions, and these should be identified and treated as soon as possible for the donor's own longer term wellbeing. In this retrospective cohort study, we investigated the risk of loss to follow-up after kidney donation for living donors. METHODS Data were collected from the unique Caledonian nephrology medical record software and a phone survey. We evaluated the association between being lost to follow up and donor recipient relationship, donor socio-demographic characteristics, donation characteristics and care access. We performed a multivariate analysis to identify risk factors of loss to follow-up. RESULTS Among the the 86 donors included, 38 (44%) had no nephrology consultation for more than 16 months. The rate of donor follow up decreased from 81% at 2 years to 49% at 10 years after donation. In the multivariate analysis, age less than 45 years old at donation increased the risk of loss to follow up to 4.5 (95% CI 2.0-10.3) and not being a spouse increased the risk to 3.9 (95% CI 1.5-11.1). CONCLUSION To conclude, efforts should be made to improve the rate at which donors are followed up in New Caledonia with special attention to younger donors and donors without a marital link with the recipient.
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Affiliation(s)
- Noémie Baroux
- Chronic Kidney Disease Network, Noumea, New Caledonia
| | | | - Thomas Lamy
- Nephrology Unit, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Véronique Biche
- Nephrology Unit, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Kate Wyburn
- Department of Renal medicine, Royal Prince Alfred Hospital & Sydney, Camperdown, New South Wales, Australia
| | - Nicolas Quirin
- Chronic Kidney Disease Network, Noumea, New Caledonia.,Nephrology Unit, Centre Hospitalier Territorial, Noumea, New Caledonia
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Dhalla A, Lloyd A, Lentine KL, Garg AX, Quinn RR, Ravani P, Klarenbach SW, Hemmelgarn BR, Ibelo U, Lam NN. Long-Term Outcomes for Living Kidney Donors With Early Guideline-Concordant Follow-up Care: A Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231158067. [PMID: 36875057 PMCID: PMC9983079 DOI: 10.1177/20543581231158067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/18/2023] [Indexed: 03/06/2023] Open
Abstract
Background Current guidelines recommend that living kidney donors receive lifelong annual follow-up care to monitor kidney health. In the United States, the reporting of complete clinical and laboratory data for kidney donors has been mandated for the first 2 years post-donation; however, the long-term impact of early guideline-concordant care remains unclear. Objective The primary objective of this study was to compare long-term post-donation follow-up care and clinical outcomes of living kidney donors with and without early guideline-concordant follow-up care. Design Retrospective, population-based cohort study. Setting Linked health care databases were used to identify kidney donors in Alberta, Canada. Patients Four hundred sixty living kidney donors who underwent nephrectomy between 2002 and 2013. Measurements The primary outcome was continued annual follow-up at 5 and 10 years (adjusted odds ratio with 95% confidence interval, LCLaORUCL). Secondary outcomes included mean change in estimated glomerular filtration rate (eGFR) over time and rates of all-cause hospitalization. Methods We compared long-term follow-up and clinical outcomes for donors with and without early guideline-concordant care, defined as annual physician visit and serum creatinine and albuminuria measurement for the first 2 years post-donation. Results Of the 460 donors included in this study, 187 (41%) had clinical and laboratory evidence of guideline-concordant follow-up care throughout the first 2 years post-donation. The odds of receiving annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR 0.180.240.32) and 68% lower at 10 years (aOR 0.230.320.46) compared with donors with early care. The odds of continuing follow-up remained stable over time for both groups. Early guideline-concordant follow-up care did not appear to substantially influence eGFR or hospitalization rates over the longer term. Limitations We were unable to confirm whether the lack of physician visits or laboratory data in certain donors was due to physician or patient decisions. Conclusions Although policies directed toward improving early donor follow-up may encourage continued follow-up, additional strategies may be necessary to mitigate long-term donor risks.
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Affiliation(s)
- Anisha Dhalla
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Anita Lloyd
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, MO, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Robert R Quinn
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Pietro Ravani
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Scott W Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Brenda R Hemmelgarn
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Uchenna Ibelo
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ngan N Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada
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Al Ammary F, Muzaale AD, Tantisattamoa E, Hanna RM, Reddy UG, Bunnapradist S, Kalantar-Zadeh K. Changing landscape of living kidney donation and the role of telemedicine. Curr Opin Nephrol Hypertens 2023; 32:81-88. [PMID: 36444666 PMCID: PMC9713599 DOI: 10.1097/mnh.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW There has been a decline in living kidney donation over the last two decades. Donors from low-income families or racial/ethnic minorities face greater disproportionate geographic, financial, and logistical barriers to completing lengthy and complex evaluations. This has contributed to the decreased proportion of these subgroups. The authors view telemedicine as a potential solution to this problem. RECENT FINDINGS Since the initial decline of donors in 2005, biologically related donors have experienced a lack of growth across race/ethnicity. Conversely, unrelated donors have emerged as the majority of donors in recent years across race/ethnicity, except for unrelated black donors. Disparities in access to living kidney donation persist. Telemedicine using live-video visits can overcome barriers to access transplant centers and facilitate care coordination. In a U.S. survey, nephrologists, surgeons, coordinators, social workers, and psychologists/psychologists across transplant centers are favorably disposed to use telemedicine for donor evaluation/follow-up beyond the coronavirus disease 2019 pandemic. However, with the waning of relaxed telemedicine regulations under the Public Health Emergency, providers perceive payor policy and out-of-state licensing as major factors hindering telemedicine growth prospects. SUMMARY Permanent federal and state policies that support telemedicine services for living kidney donation can enhance access to transplant centers and help overcome barriers to donor evaluation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramy M. Hanna
- Department of Medicine, University of California Irvine, Orange, California
| | - Uttam G. Reddy
- Department of Medicine, University of California Irvine, Orange, California
| | - Suphamai Bunnapradist
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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6
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Lam NN, Muiru AN, Tietjen A, Hays RE, Xiao H, Garg AX, McNatt G, Howey R, Thomas CP, Sarabu N, Wooley C, Kasiske BL, Lentine KL. Associations of Lack of Insurance and Other Sociodemographic Traits With Follow-up After Living Kidney Donation. Am J Kidney Dis 2022; 80:683-685. [PMID: 35301049 DOI: 10.1053/j.ajkd.2022.01.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/14/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Ngan N Lam
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Rebecca E Hays
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | | | - Gwen McNatt
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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7
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Al Ammary F, Motter JD, Sung HC, Lentine KL, Sharfuddin A, Kumar V, Yadav A, Doshi MD, Virmani S, Concepcion BP, Grace T, Sidoti CN, Yahya Jan M, Muzaale AD, Wolf J. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. Am J Transplant 2022; 22:2041-2051. [PMID: 35575439 PMCID: PMC9543040 DOI: 10.1111/ajt.17093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Hannah C. Sung
- Department of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Asif Sharfuddin
- Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Vineeta Kumar
- Department of MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Anju Yadav
- Department of MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mona D. Doshi
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarthak Virmani
- Department of MedicineYale UniversityNew HavenConnecticutUSA
| | | | - Terry Grace
- Department of MedicineWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
| | | | | | | | - Joshua Wolf
- Piedmont Transplant InstituteAtlantaGeorgiaUSA
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8
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Dayal C, Davies M, Diana NE, Meyers A. Living kidney donation in a developing country. PLoS One 2022; 17:e0268183. [PMID: 35536829 PMCID: PMC9089923 DOI: 10.1371/journal.pone.0268183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background
Living kidney donation has been advocated as a means to ameliorate the chronic shortage of organs for transplantation. Significant rates of comorbidity and familial risk for kidney disease may limit this approach in the local context; there is currently limited data describing living donation in Africa.
Methods
We assessed reasons for non-donation and outcomes following donation in a cohort of 1208 ethnically diverse potential living donors evaluated over a 32-year period at a single transplant centre in South Africa.
Results
Medical contraindications were the commonest reason for donor exclusion. Black donors were more frequently excluded (52.1% vs. 39.3%; p<0.001), particularly for medical contraindications (44% vs. 35%; p<0.001); 298 donors proceeded to donor nephrectomy (24.7%). Although no donor required kidney replacement therapy, an estimated glomerular filtration rate below 60 ml/min/1.73 m2 was recorded in 27% of donors at a median follow-up of 3.7 years, new onset albuminuria >300 mg/day was observed in 4%, and 12.8% developed new-onset hypertension. Black ethnicity was not associated with an increased risk of adverse post-donation outcomes.
Conclusion
This study highlights the difficulties of pursuing live donation in a population with significant medical comorbidity, but provides reassurance of the safety of the procedure in carefully selected donors in the developing world.
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Affiliation(s)
- Chandni Dayal
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Malcolm Davies
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nina Elisabeth Diana
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony Meyers
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- National Kidney Foundation, Johannesburg, South Africa
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Orandi BJ, Reed RD, Qu H, Owens G, Brooks S, Killian AC, Kumar V, Sheikh SS, Cannon RM, Anderson DJ, Lewis CE, Locke JE. Donor‐reported barriers to living kidney donor follow‐up. Clin Transplant 2022; 36:e14621. [PMID: 35184328 PMCID: PMC9098679 DOI: 10.1111/ctr.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite regulations mandating follow-up laboratory testing for living kidney donors, less than half of transplant centers are in compliance. We sought to understand barriers to follow-up testing from the donors' perspective. METHODS We surveyed our center's living kidney donors. Binary logistic regression was used to assess factors associated with follow-up testing completion. RESULTS Of 185 living kidney donors, 110 (59.4%) participated. Among them, 82 (74.5%) completed 6-month laboratory testing, 76 (69.1%) completed 12-month testing, 68 (61.8%) completed both, and 21 (19.0%) completed neither. Six-month testing completion was strongly associated with 12-month testing completion (OR 9.74, 95%CI: 2.23-42.50; p = .002). Those who disagreed with the statements, "Getting labs checked wasn't a priority for me," (OR for completing 6-month testing: 15.05, 95%CI: 3.70-61.18; p < .001; OR for completing 12-month testing: 5.85, 95%CI: 1.94-17.63; p = .002); and, "I forgot to get labs drawn [until I was reminded]" (OR for completing 6-month testing: 6.93, 95%CI: 1.59-30.08; p = .01; OR for completing 12-month testing: 6.55, 95%CI: 1.98-21.63; p = .002) were more likely to complete testing. CONCLUSIONS To our knowledge, this is the only study providing perspective on donor insights regarding the need for follow-up testing post donation. Interventions to influence living donor attitudes toward follow-up testing may improve follow-up.
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Affiliation(s)
- Babak J. Orandi
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Rhiannon D. Reed
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Haiyan Qu
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Grace Owens
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Sydney Brooks
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - A. Cozette Killian
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Vineeta Kumar
- University of Alabama at Birmingham Department of Medicine Division of Nephrology Birmingham AL United States
| | - Saulat S. Sheikh
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Robert M. Cannon
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Douglas J. Anderson
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Cora E. Lewis
- University of Alabama at Birmingham School of Public Health Department of Epidemiology Birmingham AL United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
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10
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Factors Associated With Residual Kidney Function and Proteinuria After Living Kidney Donation in the United States. Transplantation 2021; 105:372-381. [PMID: 32150042 DOI: 10.1097/tp.0000000000003210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living kidney donors are carefully screened, but despite overall good health, long-term donor outcomes have been shown to vary by predonation demographics. Since 2013, the United Network for Organ Sharing has mandated 2-year postdonation follow-up with measurements of kidney function and proteinuria. METHODS Using data from the Scientific Registry of Transplant Recipients, we sought to analyze donor factors associated with the percent change of kidney function from baseline (predonation) to 2-year postdonation, along with incidence of proteinuria reported within the same follow-up period. RESULTS Older donor age, male gender, black race, and body mass index >25 kg/m2 were independently associated with a greater percent decline in estimated glomerular filtration rate (eGFR). Male gender, black race, and higher body mass index were also independently associated with incident proteinuria. In contrast, younger donor age was associated with proteinuria, but proteinuria did not correlate with greater decline in eGFR in the overall cohort. CONCLUSIONS Donor factors associated with lower eGFR at 2-year postdonation were similar to those previously found to be associated with long-term risk for end-stage renal disease. Early postdonation assessment of kidney function and proteinuria may help to identify donors who are at greater risk of end-stage renal disease and who may benefit from more intense long-term monitoring.
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11
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Levan ML, Waldram MM, DiBrito SR, Thomas AG, Al Ammary F, Ottman S, Bannon J, Brennan DC, Massie AB, Scalea J, Barth RN, Segev DL, Garonzik-Wang JM. Financial incentives versus standard of care to improve patient compliance with live kidney donor follow-up: protocol for a multi-center, parallel-group randomized controlled trial. BMC Nephrol 2020; 21:465. [PMID: 33167882 PMCID: PMC7654057 DOI: 10.1186/s12882-020-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. METHODS/DESIGN We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. DISCUSSION Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. TRIAL REGISTRATION ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.
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Affiliation(s)
- Macey L. Levan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
| | - Madeleine M. Waldram
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Sandra R. DiBrito
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Alvin G. Thomas
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
| | - Fawaz Al Ammary
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Shane Ottman
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Jaclyn Bannon
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Daniel C. Brennan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Allan B. Massie
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Joseph Scalea
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Rolf N. Barth
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Dorry L. Segev
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Jacqueline M. Garonzik-Wang
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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13
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Melkonian V, Nguyen MTJP. Managing the Obese Living Kidney Donor. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors. Transplantation 2020; 103:1450-1456. [PMID: 31241556 DOI: 10.1097/tp.0000000000002508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living kidney donors in the United States who were obese at donation are at increased risk of end-stage renal disease and may benefit from intensive postdonation follow-up. However, they are less likely to have complete follow-up data. Center variation and risk factors for incomplete follow-up are unknown. METHODS Adult living kidney donors with obesity (body mass index, ≥30 kg/m) at donation reported to the Scientific Registry of Transplant Recipients from January 2005 to July 2015 were included (n = 13 831). Donor characteristics were compared by recorded serum creatinine at 6 months postdonation, and multilevel logistic regression models were used to estimate odds of 6-month creatinine. RESULTS After adjustment, older age, female sex, and donation after implementation of new center follow-up requirements were associated with higher odds of 6-month creatinine, with lower odds for obese donors with a history of smoking, biologically related donors, and at centers with higher total living donor volume. 23% of variation in recorded 6-month serum creatinine among obese donors was attributed to center (intraclass correlation coefficient: 0.232, P < 0.001). The adjusted probability of 6-month creatinine by center ranged from 10% to 91.5%. CONCLUSIONS Tremendous variation in recorded 6-month postdonation serum creatinine exists among obese living donors, with high volume centers having the lowest probability of follow-up. Moreover, individual-level characteristics such as age, sex, and relationship to recipient were associated with recorded 6-month creatinine. Given increased risk for end-stage renal disease among obese living donors, center-level efforts targeted specifically at increasing postdonation follow-up among obese donors should be developed and implemented.
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15
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Lam NN, Lloyd A, Lentine KL, Quinn RR, Ravani P, Hemmelgarn BR, Klarenbach S, Garg AX. Changes in kidney function follow living donor nephrectomy. Kidney Int 2020; 98:176-186. [PMID: 32571482 DOI: 10.1016/j.kint.2020.03.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 01/28/2023]
Abstract
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year (95% confidence interval +0.21 to +0.48) in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year (-0.94 to -0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Krista L Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pietro Ravani
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
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16
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Ambagtsheer F, Haase-Kromwijk B, Dor FJMF, Moorlock G, Citterio F, Berney T, Massey EK. Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal. Transpl Int 2020; 33:989-998. [PMID: 32349176 PMCID: PMC7540591 DOI: 10.1111/tri.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low- and middle-income countries, and detracts from the aim of self-sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Franco Citterio
- Renal Transplantation Unit, Fondazione Policlinico Universitario, A. Gemelli, Rome, Italy
| | - Thierry Berney
- Division of Transplantation, University of Geneva Hospitals, Geneva, Switzerland
| | - Emma K Massey
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
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17
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Massie AB, Holscher CM, Henderson ML, Fahmy LM, Thomas AG, Al Ammary F, Getsin SN, Snyder JJ, Lentine KL, Garg AX, Segev DL. Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors. JAMA Surg 2020; 155:e195472. [PMID: 31968070 DOI: 10.1001/jamasurg.2019.5472] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Living kidney donation is associated with increased long-term risk of end-stage renal disease (ESRD). An early postdonation marker of ESRD risk could improve postdonation risk assessment and counseling for kidney donors and allow early intervention for donors at increased risk. Objective To determine the association between renal function in the first 6 months postdonation and subsequent risk of ESRD in kidney donors. Design, Setting, and Participants This secondary analysis of a prospective national cohort uses a population-based registry of all living kidney donors in the United States between October 26, 1999, and January 1, 2018, with follow-up through December 31, 2018. All kidney donors who had donated in the date range and had serum creatinine measured at 6 months (±3 months) postdonation were included. Exposures Renal function as measured by estimated glomerular filtration rate 6 months after donation (eGFR6). Main Outcomes and Measures End-stage renal disease, ascertained via linkage to Centers for Medicare & Medicaid Services data. Results A total of 71 468 living kidney donors were included (of 109 065 total donors over this period). Their median (interquartile range) eGFR6 was 63 (54-74) mL/min/1.73 m2. Cumulative incidence of ESRD at 15 years postdonation ranged from 11.7 donors per 10 000 donors with eGFR6 values greater than 70 mL/min/1.73 m2 to 33.1 donors per 10 000 donors with eGFR6 values of 50 mL/min/1.73 m2 or less. Adjusting for age, race, sex, body mass index, and biological relationship, every 10 mL/min/1.73 m2 reduction in eGFR6 was associated with a 28% increased risk of ESRD (adjusted hazard ratio, 1.28 [95% CI, 1.06-1.54]; P = .009). The association between predonation eGFR and ESRD was not significant and was fully mediated by eGFR6 (adjusted hazard ratio, 1.00 [95% CI, 0.86-1.17]; P = .97). The postdonation eGFR value was a better marker of ESRD than eGFR decline after donation or the ratio of eGFR6 to predonation eGFR, as determined by the Akaike information criterion (in which a lower value indicates a better model fit; eGFR6, 1495.61; predonation eGFR - eGFR6, 1503.58; eGFR6 / predonation eGFR, 1502.30). Conclusions and Relevance In this study, there was an independent association of eGFR6 with subsequent ESRD risk in living kidney donors, even after adjusting for predonation characteristics. The findings support measurement of early postdonation serum creatinine monitoring in living kidney donors, and the use of these data to help identify donors who might need more careful surveillance and early intervention.
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Affiliation(s)
- Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara M Fahmy
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fawaz Al Ammary
- Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samantha N Getsin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Krista L Lentine
- Center for Abdominal Transplantation, St Louis University, St Louis, Missouri
| | - Amit X Garg
- Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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18
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Eno AK, Ruck JM, Van Pilsum Rasmussen SE, Waldram MM, Thomas AG, Purnell TS, Garonzik Wang JM, Massie AB, Al Almmary F, Cooper LM, Segev DL, Levan MA, Henderson ML. Perspectives on implementing mobile health technology for living kidney donor follow-up: In-depth interviews with transplant providers. Clin Transplant 2019; 33:e13637. [PMID: 31194892 PMCID: PMC6690770 DOI: 10.1111/ctr.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND United States transplant centers are required to report follow-up data for living kidney donors for 2 years post-donation. However, living kidney donor (LKD) follow-up is often incomplete. Mobile health (mHealth) technologies could ease data collection burden but have not yet been explored in this context. METHODS We conducted semi-structured in-depth interviews with a convenience sample of 21 transplant providers and thought leaders about challenges in LKD follow-up, and the potential role of mHealth in overcoming these challenges. RESULTS Participants reported challenges conveying the importance of follow-up to LKDs, limited data from international/out-of-town LKDs, and inadequate staffing. They believed the 2-year requirement was insufficient, but expressed difficulty engaging LKDs for even this short time and inadequate resources for longer-term follow-up. Participants believed an mHealth system for post-donation follow-up could benefit LKDs (by simplifying communication/tasks and improving donor engagement) and transplant centers (by streamlining communication and decreasing workforce burden). Concerns included cost, learning curves, security/privacy, patient language/socioeconomic barriers, and older donor comfort with mHealth technology. CONCLUSIONS Transplant providers felt that mHealth technology could improve LKD follow-up and help centers meet reporting thresholds. However, designing a secure, easy to use, and cost-effective system remains challenging.
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Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Fawaz Al Almmary
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa M Cooper
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
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19
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20
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Frech A, Natale G, Tumin D. Couples' employment after spousal kidney donation. SOCIAL WORK IN HEALTH CARE 2018; 57:880-889. [PMID: 30300111 DOI: 10.1080/00981389.2018.1523823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We used data from the United Network for Organ Sharing registry of living kidney donors and recipients to identify correlates of paid employment among couples following spousal living donation. Among such couples, post-transplant employment of both spouses (41%) was as common as employment of the donor only (41%). However, when the recipient was female, donor-only employment after transplant was more than twice as likely as compared to employment of both spouses (relative risk ratio = 2.57; p < .001). We conclude that traditional gender roles regarding paid workforce participation may be associated with the likelihood of employment after spousal kidney donation.
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Affiliation(s)
- Adrianne Frech
- a Department of Health Sciences , University of Missouri , Columbia , Missouri , USA
| | - Ginny Natale
- b Department of Sociology , Kent State University , Kent , Ohio , USA
| | - Dmitry Tumin
- c Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA
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21
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Follow-up Status of Living Kidney Donors After Transplantation. Transplant Proc 2018; 50:2346-2349. [PMID: 30316355 DOI: 10.1016/j.transproceed.2018.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to identify the follow-up status of living kidney donors after transplantation. METHODS This study was a secondary analysis of the medical record data from one hospital in Korea. Eighty-one donors from February 2010 to April 2016 were selected for analysis of follow-up status. Data were analyzed using descriptive statistics, Kaplan-Meier estimator, and Cox regression. RESULTS Overall, 48.4% of donors continued to participate in follow-up visits. Donor follow-up rates at 1, 2, and 3 years were 75.1%, 58.2%, and 48.4%, respectively. Significant predictors of follow-up loss among donors were smoking habit and the type of follow-up health care provider. CONCLUSION For management of the physical and psychological health of donors, continuous care by the nephrologist and surgeon is required following transplantation.
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22
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Eno AK, Thomas AG, Ruck JM, Van Pilsum Rasmussen SE, Halpern SE, Waldram MM, Muzaale AD, Purnell TS, Massie AB, Garonzik Wang JM, Lentine KL, Segev DL, Henderson ML. Assessing the Attitudes and Perceptions Regarding the Use of Mobile Health Technologies for Living Kidney Donor Follow-Up: Survey Study. JMIR Mhealth Uhealth 2018; 6:e11192. [PMID: 30305260 PMCID: PMC6231841 DOI: 10.2196/11192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States. OBJECTIVE The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up. METHODS We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up. RESULTS Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively. CONCLUSIONS Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up.
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Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Duke University School of Medicine, Durham, NC, United States
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.,Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | | | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
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23
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Lam NN, Lentine KL, Hemmelgarn B, Klarenbach S, Quinn RR, Lloyd A, Gourishankar S, Garg AX. Follow-up Care of Living Kidney Donors in Alberta, Canada. Can J Kidney Health Dis 2018; 5:2054358118789366. [PMID: 30083366 PMCID: PMC6073841 DOI: 10.1177/2054358118789366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022] Open
Abstract
Background Previous guidelines recommend that living kidney donors receive lifelong annual follow-up care to assess renal health. Objective To determine whether these best practice recommendations are currently being followed. Design Retrospective cohort study using linked health care databases. Setting Alberta, Canada (2002-2014). Patients Living kidney donors. Measurements We determined the proportion of donors who had annual outpatient physician visits and laboratory measurements for serum creatinine and albuminuria. Results There were 534 living kidney donors with a median follow-up of 7 years (maximum 13 years). The median age at the time of donation was 41 years and 62% were women. Overall, 25% of donors had all 3 markers of care (physician visit, serum creatinine, albuminuria measurement) in each year of follow-up. Adherence to physician visits was higher than serum creatinine or albuminuria measurements (67% vs 31% vs 28% of donors, respectively). Donors with guideline-concordant care were more likely to be older, reside closer to the transplant center, and receive their nephrectomy in more recent years. Limitations Our results may not be generalizable to other countries that do not have a similar universal health care system. Conclusions These findings suggest significant evidence-practice gaps, in that the majority of donors saw a physician, but the minority had measurements of kidney function or albuminuria. Future interventions should target improving follow-up care for all donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Brenda Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, AB, Canada.,Departments of Medicine & Community Health Sciences, University of Calgary, AB, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, AB, Canada.,Departments of Medicine & Community Health Sciences, University of Calgary, AB, Canada
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Sita Gourishankar
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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24
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Frech A, Natale G, Hayes D, Tumin D. Marital Status and Return to Work After Living Kidney Donation. Prog Transplant 2018; 28:226-230. [PMID: 29879858 DOI: 10.1177/1526924818781560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Living kidney donation is safe and effective, but patients in need of a transplant continue to outnumber donors. Disincentives to living donation include lost income, risk of job loss, perioperative complications, and unreimbursed medical expenses. METHODS This study uses US registry and follow-up data on living kidney donors from 2013 to 2015 to identify social predictors of return to work across gender following living kidney donation. RESULTS Using logistic regression, we find that predictors of return to work following living kidney donation differ for women and men. Among women, age, education, smoking status, and procedure type are associated with return to work. Among men, education, procedure type, and hospital readmission within 6 weeks postdonation are associated with return to work. Notably, single and divorced men are less likely to return to work compared to married men (odds ratio [OR] for single men 0.51, 95% confidence interval [CI], 0.37-0.69, P < .001; OR for divorced men 0.51, 95% CI, 0.34-0.75, P = .006). Marital status is not associated with return to work for women. Single and divorced men's greater odds of not returning to work are robust to controls for relevant pre- and postdonation characteristics. CONCLUSIONS Single and divorced men's lack of social support may present an obstacle to work resumption following living kidney donation.
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Affiliation(s)
- Adrianne Frech
- 1 Department of Health Sciences, University of Missouri, Kent State University, Ginny Natale, MA, USA
| | | | - Don Hayes
- 3 Nationwide Children's Hospital, Columbus, OH USA
| | - Dmitry Tumin
- 4 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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25
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Lam NN, Lentine KL, Klarenbach S, Sood MM, Kuwornu PJ, Naylor KL, Knoll GA, Kim SJ, Young A, Garg AX. Validation of Living Donor Nephrectomy Codes. Can J Kidney Health Dis 2018; 5:2054358118760833. [PMID: 29662679 PMCID: PMC5896849 DOI: 10.1177/2054358118760833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background: Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up. Objective: To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review. Design: Retrospective cohort study. Setting: 5 major transplant centers in Ontario, Canada. Patients: Living kidney donors between 2003 and 2010. Measurements: Sensitivity and positive predictive value (PPV). Methods: Using administrative databases, we conducted a retrospective study to determine the validity of diagnostic and procedural codes for living donor nephrectomies. The reference standard was living donor nephrectomies identified through the province’s tissue and organ procurement agency, with verification by manual chart review. Operating characteristics (sensitivity and PPV) of various algorithms using diagnostic, procedural, and physician billing codes were calculated. Results: During the study period, there were a total of 1199 living donor nephrectomies. Overall, the best algorithm for identifying living kidney donors was the presence of 1 diagnostic code for kidney donor (ICD-10 Z52.4) and 1 procedural code for kidney procurement/excision (1PC58, 1PC89, 1PC91). Compared with the reference standard, this algorithm had a sensitivity of 97% and a PPV of 90%. The diagnostic and procedural codes performed better than the physician billing codes (sensitivity 60%, PPV 78%). Limitations: The donor chart review and validation study was performed in Ontario and may not be generalizable to other regions. Conclusions: An algorithm consisting of 1 diagnostic and 1 procedural code can be reliably used to conduct health services research that requires the accurate determination of living kidney donors at the population level.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, MO, USA
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Manish M Sood
- Department of Medicine, Division of Nephrology, Kidney Research Centre, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
| | - Paul J Kuwornu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Kyla L Naylor
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Gregory A Knoll
- Department of Medicine, Division of Nephrology, Kidney Research Centre, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
| | - S Joseph Kim
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, Ontario, Canada
| | - Ann Young
- Department of Medicine, Division of Nephrology, University of Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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26
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Ruck JM, Zhou S, Thomas AG, Cramm SL, Massie AB, Montgomery JR, Berger JC, Henderson ML, Segev DL. Electronic messaging and communication with living kidney donors. Clin Transplant 2017; 32. [PMID: 29281129 DOI: 10.1111/ctr.13184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 01/16/2023]
Abstract
New regulations require living kidney donor (LKD) follow-up for 2 years, but donor retention remains poor. Electronic communication (eg, text messaging and e-mail) might improve donor retention. To explore the possible impact of electronic communication, we recruited LKDs to participate in an exploratory study of communication via telephone, e-mail, or text messaging postdonation; communication through this study was purely optional and did not replace standard follow-up. Of 69 LKDs recruited, 3% requested telephone call, 52% e-mail, and 45% text messaging. Telephone response rate was 0%; these LKDs were subsequently excluded from analysis. Overall response rates with e-mail or text messaging at 1 week, 1 month, 6 months, 1 year, and 2 years were 94%, 87%, 81%, 72%, and 72%. Lower response rates were seen in African Americans, even after adjusting for age, sex, and contact method (incidence rate ratio (IRR) nonresponse 2.07 5.8116.36 , P = .001). Text messaging had higher response rates than e-mail (IRR nonresponse 0.11 0.280.71 , P = .007). Rates of nonresponse were similar by sex (IRR 0.68, P = .4) and age (IRR 1.00, P > .9). In summary, LKDs strongly preferred electronic messaging over telephone and were highly responsive 2 years postdonation, even in this nonrequired, nonincentivized exploratory research study. These electronic communication tools can be automated and may improve regulatory compliance and postdonation care.
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Affiliation(s)
- Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng Zhou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon L Cramm
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - John R Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Berger
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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27
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Expectations and Experiences of Follow-up and Self-Care After Living Kidney Donation: A Focus Group Study. Transplantation 2017; 101:2627-2635. [PMID: 28538499 DOI: 10.1097/tp.0000000000001771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ensuring donor wellbeing warrants ongoing monitoring after living kidney donation. However, there is considerable variability in donor follow-up processes, including information provided to donors regarding self-care. Loss to follow-up is common, suggesting that the aims and benefits of monitoring and follow-up may not be apparent. We aimed to describe the experiences and expectations of living kidney donors regarding follow-up and self-care after donation. METHODS Participants from 3 transplant centers in Australia and Canada participated in 14 focus groups (n = 123). Transcripts were analyzed thematically. RESULTS We identified 4 themes: lacking identification as a patient (invincibility and confidence in health, immediate return to normality, avoid burdening specialty services, redundancy of specialist attention, unnecessary travel), empowerment for health (self-preservation for devastating consequences, self-advocacy and education, needing lifestyle advice, tracking own results), safety net and reassurance (availability of psychosocial support, confidence in kidney-focused care, continuity and rapport, and access to waitlist priority), and neglect and inattention (unrecognized ongoing debilitations, primary focus on recipient, hospital abandonment, overlooking individual priorities, disconnected from system, coping with dual roles, and lacking support for financial consequences). CONCLUSIONS Living kidney donors who felt well and confident about their health regarded specialist follow-up as largely unnecessary. However, some felt they did not receive adequate medical attention, were prematurely detached from the health system, or held unresolved anxieties about the consequences of their decision to donate. Ongoing access to healthcare, psychosocial support, and education may reassure donors that any risks to their health are minimized.
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28
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Abstract
BACKGROUND The Organ Procurement and Transplantation Network requires that United States transplant centers maintain follow-up with living donors for 2 years postdonation, but lack of donor follow-up is pervasive. Donor characteristics, including younger age, minority race, and lower education, have been associated with incomplete follow-up, but it is unknown whether altruistic donors, having no previous connection to their recipient, differ from traditional donors in their likelihood of follow-up. METHODS Using the Scientific Registry of Transplant Recipients data, we examined all adult living kidney donors from 2005 to 2015 (n = 63 592) classified as altruistic or traditional, and compared likelihood of 6-month medical follow-up using modified Poisson regression. RESULTS Altruistic donors did not differ from traditional donors in likelihood of follow-up (adjusted relative risk [aRR], 1.02; 95% confidence interval [CI], 0.99-1.06). Among previously identified at-risk subgroups, however, altruistic donors were more likely to have follow-up than their traditional counterparts, including those who were younger (aRR, 1.04; 95% CI, 1.00-1.09), had less than college education (aRR, 1.05; 95% CI, 1.00-1.11), and were unmarried (aRR, 1.08; 95% CI, 1.04-1.12). Having medical follow-up at 6 months was significantly associated with having follow-up at 1 year (aRR, 1.84; 95% CI, 1.75-1.93) and 2 years (aRR, 1.63; 95% CI, 1.56-1.70) postdonation. CONCLUSIONS These data provide additional granularity on living donor phenotypes associated with short-term (6 month) postdonation follow-up, which is important given its association with future likelihood of follow-up. These findings offer the opportunity to tailor and direct educational efforts to increase living donor follow-up, particularly among groups at higher risk of loss to follow-up.
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29
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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30
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Li T, Dokus MK, Kelly KN, Ugoeke N, Rogers JR, Asham G, Sharma VA, Cirillo DJ, Robinson MK, Venniro EK, Taylor JG, Orloff MS, McIntosh S, Kashyap R. Survey of Living Organ Donors' Experience and Directions for Process Improvement. Prog Transplant 2017; 27:232-239. [PMID: 29187096 DOI: 10.1177/1526924817715467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Understanding living organ donors' experience with donation and challenges faced during the process is necessary to guide the development of effective strategies to maximize donor benefit and increase the number of living donors. METHODS An anonymous self-administered survey, specifically designed for this population based on key informant interviews, was mailed to 426 individuals who donated a kidney or liver at our institution. Quantitative and qualitative methods including open and axial coding were used to analyze donor responses. FINDINGS Of the 141 survey respondents, 94% would encourage others to become donors; however, nearly half (44%) thought the donation process could be improved and offered numerous suggestions. Five major themes arose: (1) desire for greater convenience in testing and scheduling; (2) involvement of previous donors throughout the process; (3) education and promotion of donation through social media; (4) unanticipated difficulties, specifically pain; and (5) financial concerns. DISCUSSION Donor feedback has been translated into performance improvements at our hospital, many of which are applicable to other institutions. Population-specific survey development helps to identify vital patient concerns and provides valuable feedback to enhance the delivery of care.
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Affiliation(s)
- Timmy Li
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.,2 Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - M Katherine Dokus
- 3 Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.,4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA
| | - Kristin N Kelly
- 3 Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Nene Ugoeke
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - James R Rogers
- 5 College of Arts and Sciences, University of Rochester, Rochester, NY, USA
| | - George Asham
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.,6 Department of Cell Biology and Neuroscience, Rutgers University, New Brunswick, NJ, USA
| | - Venkatesh Abhishek Sharma
- 4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA.,5 College of Arts and Sciences, University of Rochester, Rochester, NY, USA
| | - Dominic J Cirillo
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mary K Robinson
- 4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA.,7 Department of Nephrology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika K Venniro
- 4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA.,7 Department of Nephrology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeremy G Taylor
- 4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA.,7 Department of Nephrology, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark S Orloff
- 3 Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.,4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McIntosh
- 1 Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Randeep Kashyap
- 3 Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.,4 Center for Transplantation, University of Rochester Medical Center, Rochester, NY, USA
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31
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Alejo JL, Luo X, Massie AB, Henderson ML, DiBrito SR, Locke JE, Purnell TS, Boyarsky BJ, Anjum S, Halpern SE, Segev DL. Patterns of primary care utilization before and after living kidney donation. Clin Transplant 2017; 31:10.1111/ctr.12992. [PMID: 28457016 PMCID: PMC5731477 DOI: 10.1111/ctr.12992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health postdonation, yet adherence to this recommendation is unknown. METHODS We surveyed 1170 living donors from our center from 1970 to 2012 to ascertain frequency of PCP visits pre- and postdonation. Interviews occurred median (IQR) 6.6 (3.8-11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. RESULTS Overall, only 18.6% had less-than-annual PCP follow-up postdonation. The strongest predictor of postdonation PCP visit frequency was predonation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits postdonation (OR=9.8 14.421.0, P<.001). Men were more likely to report less-than-annual PCP visits postdonation (adjusted OR=1.2 1.62.3, P<.01); this association was amplified in unmarried/noncohabiting men (aOR=2.4 3.96.3, P<.001). Donors without college education were also more likely to report less-than-annual PCP visits postdonation (aOR=1.3 1.82.5 , P=.001). CONCLUSIONS The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men), and donors who did not see their PCP annually before donation.
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Affiliation(s)
- Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saad Anjum
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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32
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Abstract
There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process.
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Affiliation(s)
- Mohamed Y. Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA
| | - Joseph L. Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA
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33
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Matas AJ, Hays RE, Ibrahim HN. A Case-Based Analysis of Whether Living Related Donors Listed for Transplant Share ESRD Causes with Their Recipients. Clin J Am Soc Nephrol 2017; 12:663-668. [PMID: 28249957 PMCID: PMC5383394 DOI: 10.2215/cjn.11421116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Two recent studies reported increased risk of ESRD after kidney donation. In both, the majority of ESRD was seen in those donating to a relative. Confounding this observation is that, in the absence of donation, relatives of those with ESRD are at increased risk for ESRD. Understanding the pathogenesis and risk factors for postdonation ESRD is critical for both donor selection and counseling. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We hypothesized that if familial relationship was an important consideration in pathogenesis, the donor and linked recipient would share ESRD etiology. We obtained information from the Organ Procurement and Transplantation Network (OPTN) on all living kidney donors subsequently waitlisted for a kidney transplant in the United States between January 1, 1996 and November 30, 2015, to determine (1) the donor-recipient relationship and (2) whether related donor-recipient pairs had similar causes of ESRD. RESULTS We found that a significant amount of information, potentially available at the time of listing, was not reported to the OPTN. Of 441 kidney donors listed for transplant, only 169 had information allowing determination of interval from donation to listing, and only 99 (22% of the total) had information on the donor-recipient relationship and ESRD etiology. Of the 99 donors, 87 were related to their recipient. Strikingly, of the 87, only a minority (23%) of donor-recipient pairs shared ESRD etiology. Excluding hypertension, only 8% shared etiology. CONCLUSIONS A better understanding of ESRD in donors requires complete and detailed data collection, as well as a method to capture all ESRD end points. This study highlights the absence of critical information that is urgently needed to provide a meaningful understanding of ESRD after kidney donation. We found that of living related donors listed for transplant, where both donor and recipient cause of ESRD is recorded, only a minority share ESRD etiology with their recipient.
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Affiliation(s)
| | - Rebecca E. Hays
- Division of Transplantation, Transplant Clinic, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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34
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Torres X, Comas J, Arcos E, Tort J, Diekmann F. Death of recipients after kidney living donation triples donors' risk of dropping out from follow-up: a retrospective study. Transpl Int 2017; 30:603-610. [PMID: 28252226 DOI: 10.1111/tri.12946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 08/25/2016] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
Although kidney transplantation from the donation of a living donor is a safe treatment for end-stage renal disease, inferences about safety of living kidney donors might be biased by an informative censoring caused by the noninclusion of a substantial percentage of donors lost to follow-up. With the aim of assessing the presence of a potential informative censoring in living kidney donation outcomes of Catalan donors for a period of 12 years, 573 donors followed and lost to follow-up were compared. Losses of follow-up over time were also assessed by univariate and multivariate survival analysis, along with Cox regression. Younger and older ages, and the death of their recipient differentiated those donors who were lost to follow-up over time. The risk of dropping out from follow-up was more than twofold for the youngest and oldest donors, and almost threefold for those donors whose recipient died. Results of studies on postdonation outcomes of Catalan living kidney donors might have overlooked older and younger cases, and, remarkably, a percentage of donors whose recipient died. If these donors showed a higher incidence of psychological problems, conclusions about living donors' safety might be compromised thus emphasizing the necessity of sustained surveillance of donors and prompt identification of these cases.
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Affiliation(s)
- Xavier Torres
- Psychiatry and Clinical Psychology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Comas
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Emma Arcos
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Jaume Tort
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain
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35
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Kulkarni S, Thiessen C, Formica RN, Schilsky M, Mulligan D, D'Aquila R. The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors. Am J Transplant 2016; 16:3385-3391. [PMID: 27500361 DOI: 10.1111/ajt.14005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 01/25/2023]
Abstract
Transplant professionals recognize that the long-term follow-up of living organ donors is a priority, yet there has been no implemented solution to this problem. This critical gap is essential, because the transplant field is now emphasizing living donation as a means to address the organ shortage. We detail our living donor initiative, which sets several priorities we recognize as fundamental to persons who have donated organs at our transplant center. This intervention attempts to mitigate the donor and center factors that are known to contribute to the lack of long-term follow-up. Beyond that, our goals are aimed at providing ongoing engagement, wellness, clinical data accrual, laboratory follow-up, and social support for our living donors, in continuity. Our ultimate goal is to nurture the development of local living donor community networks by providing social engagement for current and past donors, which also serves as a platform for greater population education on the societal importance of living donation. This initiative is based on joint recognition by our transplant team and our hospital leadership that supporting the long-term welfare of living donors is essential to accomplishing the goal of expanding living donor transplantation. The transplant team and hospital missions are aligned, and both contribute resources to the initiative.
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Affiliation(s)
- S Kulkarni
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - C Thiessen
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - R N Formica
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - M Schilsky
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - D Mulligan
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - R D'Aquila
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Office of the President, Yale-New Haven Hospital, New Haven, CT
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Rodrigue JR, Fleishman A. Health Insurance Trends in United States Living Kidney Donors (2004 to 2015). Am J Transplant 2016; 16:3504-3511. [PMID: 27088263 PMCID: PMC5069113 DOI: 10.1111/ajt.13827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 01/25/2023]
Abstract
Some transplant programs consider the lack of health insurance as a contraindication to living kidney donation. Still, prior studies have shown that many adults are uninsured at time of donation. We extend the study of donor health insurance status over a longer time period and examine associations between insurance status and relevant sociodemographic and health characteristics. We queried the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry for all living kidney donors (LKDs) between July 2004 and July 2015. Of the 53 724 LKDs with known health insurance status, 8306 (16%) were uninsured at the time of donation. Younger (18 to 34 years old), male, minority, unemployed, less educated, unmarried LKDs and those who were smokers and normotensive were more likely to not have health insurance at the time of donation. Compared to those with no health risk factors (i.e. obesity, smoking, hypertension, estimated glomerular filtration rate <60, proteinuria) (14%), LKDs with 1 (18%) or ≥2 (21%) health risk factors at the time of donation were more likely to be uninsured (p < 0.0001). Among those with ≥2 health risk factors, blacks (28%) and Hispanics (27%) had higher likelihood of being uninsured compared to whites (19%; p < 0.001). Study findings underscore the importance of providing health insurance benefits to all previous and future LKDs.
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Affiliation(s)
- James R. Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Aaron Fleishman
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
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37
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Patient-Reported Outcomes Following Living Kidney Donation: A Single Center Experience. J Clin Psychol Med Settings 2016; 22:160-8. [PMID: 26123551 DOI: 10.1007/s10880-015-9424-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the development and implementation of an initiative at one transplant center to annually assess psychosocial outcomes of living kidney donors. The current analysis focuses on a cohort of adults (n = 208) who donated a kidney at BIDMC between September 2005 and August 2012, in which two post-donation annual assessments could be examined. One and two year post-donation surveys were returned by 59 % (n = 123) and 47 % (n = 98) of LKDs, respectively. Those who did not complete any survey were more likely to be younger (p = 0.001), minority race/ethnicity (p < 0.001), and uninsured at the time of donation (p = 0.01) compared to those who returned at least one of the two annual surveys. The majority of donors reported no adverse physical or psychosocial consequences of donation, high satisfaction with the donation experience, and no donation decision regret. However, a sizable minority of donors felt more pain intensity than expected and recovery time was much slower than expected, and experienced a clinically significant decline in vitality. We describe how these outcomes are used to inform clinical practice at our transplant center as well as highlight challenges in donor surveillance over time.
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Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao H, Dzebisashvili N, Schold JD, Brennan DC, Randall H, King EA, Segev DL. Perioperative Complications After Living Kidney Donation: A National Study. Am J Transplant 2016; 16:1848-57. [PMID: 26700551 DOI: 10.1111/ajt.13687] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/25/2015] [Accepted: 12/13/2015] [Indexed: 01/25/2023]
Abstract
We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.
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Affiliation(s)
- K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - N N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - D Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - M A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - A X Garg
- Division of Nephrology, Western University, London, Ontario, Canada
| | - H Xiao
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - N Dzebisashvili
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - J D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D C Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO
| | - H Randall
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - E A King
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - D L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Halverson CME, Wang JY, Poulson M, Karlin J, Crowley-Matoka M, Ross LF. Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts. Am J Nephrol 2016; 43:389-96. [PMID: 27222023 DOI: 10.1159/000446161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). METHODS Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. RESULTS Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. CONCLUSIONS Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.
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