학술논문
Impact of the Kidney Allocation Revision on Access to Kidney Transplantation and Outcomes in the United States.
Document Type
Academic Journal
Author
Akinyemi OA; Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.; Department of Health Policy and Management, University of Maryland, College Park, MD, USA.; Weldeslase TA; Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Odusanya EA; Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.; Hughes K; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Cornwell EE; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Callender CO; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Source
Publisher: SAGE Publications in association with Southeastern Surgical Congress Country of Publication: United States NLM ID: 0370522 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-9823 (Electronic) Linking ISSN: 00031348 NLM ISO Abbreviation: Am Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The 2014 Kidney Allocation System (KAS) revision aimed to enhance equity in organ allocation and improve patient outcomes. This study assesses the impacts of the KAS revision on renal transplantation demographics and outcomes in the United States.
Methods: We conducted a retrospective study utilizing the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) database from 1998 to 2022. We compared recipient and donor characteristics, and outcomes (graft failure and recipient survival) pre- and post-KAS revision.
Results: Post-KAS, recipients were significantly older (53 vs 48, P < .001) with an increase in Medicaid beneficiaries (7.3% vs 5.5%, P < .001). Despite increased graft survival, HR = .91 (95% CI 0.80-.92, P < .001), overall recipient survival decreased, HR = 1.06 (95% CI 1.04-1.09, P < .001). KAS revision led to greater racial diversity among recipients and donors, enhancing equity in organ allocation. However, disparities persist in graft failure rates and recipient survival across racial groups.
Discussion: The 2014 Kidney Allocation System revision has led to important changes in the renal transplantation landscape. While progress has been made towards increasing racial equity in organ allocation, further refinements are needed to address ongoing disparities. Recognizing the changing patient profiles and socio-economic factors will be crucial in shaping future policy modifications.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Methods: We conducted a retrospective study utilizing the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) database from 1998 to 2022. We compared recipient and donor characteristics, and outcomes (graft failure and recipient survival) pre- and post-KAS revision.
Results: Post-KAS, recipients were significantly older (53 vs 48, P < .001) with an increase in Medicaid beneficiaries (7.3% vs 5.5%, P < .001). Despite increased graft survival, HR = .91 (95% CI 0.80-.92, P < .001), overall recipient survival decreased, HR = 1.06 (95% CI 1.04-1.09, P < .001). KAS revision led to greater racial diversity among recipients and donors, enhancing equity in organ allocation. However, disparities persist in graft failure rates and recipient survival across racial groups.
Discussion: The 2014 Kidney Allocation System revision has led to important changes in the renal transplantation landscape. While progress has been made towards increasing racial equity in organ allocation, further refinements are needed to address ongoing disparities. Recognizing the changing patient profiles and socio-economic factors will be crucial in shaping future policy modifications.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.