MP85-01 GRAFT OUTCOME DISPARITY IN A SINGLE RENAL TRANSPLANT CENTER BASED ON RECIPIENT GEOGRAPHIC ORIGIN

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2015MP85-01 GRAFT OUTCOME DISPARITY IN A SINGLE RENAL TRANSPLANT CENTER BASED ON RECIPIENT GEOGRAPHIC ORIGIN Weikai Qu, Ryan Flynn, David Fumo, Timothy Suttle, Steven Selman, Michael Rees, and Jorge Ortiz Weikai QuWeikai Qu More articles by this author , Ryan FlynnRyan Flynn More articles by this author , David FumoDavid Fumo More articles by this author , Timothy SuttleTimothy Suttle More articles by this author , Steven SelmanSteven Selman More articles by this author , Michael ReesMichael Rees More articles by this author , and Jorge OrtizJorge Ortiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The disparity in access to organs for kidney transplantation has led to inter-state “transplant tourism.” Our objective was to determine if recipients traveling over a state line for kidney transplantation experience different outcomes relative to recipients native to that state. METHODS The Scientific Registry of Transplant Recipients was analyzed to examine all deceased donor kidney transplants performed from 1987-2014 (n=1094). Those transplanted in their original state were labeled O (n=775). Those Nonnative recipients were labeled N (n=319). RESULTS Demographics: Both sets of recipients received similar donor allografts except for the following (p-value<0.05): The N group received more DCD (6.9% vs 3.1%, p=0.004) and CDC high-risk donors (19.4% vs. 7.6%, p<0.001), who were on average older (mean=36.7 vs. 34.2, p=0.016) and had a higher BMI (mean=26.8 vs 25.8, p=0.001). The N group had a shorter average cold ischemic time (mean=16.6 vs. 19.1 hours, p<0.001). However Donor KDPI median was not different between groups (38% vs 35%, p=0.478). Recipient demographics: The N group contained more Asians (5.6% vs 0.3%, p<0.001), an older population (mean=54.0 vs. 48.4, p<0.001) and fewer patients using Medicaid (0.7% vs 2.7%, p=0.042). The N group also had more patients with a current PRA higher than 20% (22.8% vs 17.5%, p=0.044) but fewer patients undergoing repeat transplantation (10.3% vs. 15.9%, P=0.018). Outcomes: Patient survival was not statistically significantly different (mean time in years=13.7 vs 12.9, p=0.707). However, the N group experienced less delayed graft function (13.3% vs. 20.9%, P=0.003), improved allograft survival (mean time in years=17.1 vs 12.9, p<0.05) and a lower rate of retransplantation (3.2% vs. 13%, P<0.001). Log Rank test showed a significant difference in graft survival between education levels (p=0.043). However, when analyzed with other possible risk factors in Cox Proportional Hazard test, education level was not an independent risk factor of graft failure (p=0.153). Additionally, the incidence of rejection and rejection as a cause of graft loss were not statistically significantly different. CONCLUSIONS In this single center study, those patients traveling from outside the state of transplantation (despite similar donor and recipient demographics) demonstrated superior allograft outcomes. These superior outcomes may be tied to socio-economic factors yet to be elucidated. Other confounding factors may exist to explain these discordant results. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1067 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Weikai Qu More articles by this author Ryan Flynn More articles by this author David Fumo More articles by this author Timothy Suttle More articles by this author Steven Selman More articles by this author Michael Rees More articles by this author Jorge Ortiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...