Accumulation of unfavorable clinical and socioeconomic factors precludes living donor kidney transplantation.
BACKGROUND
In the past 30 years, the number of living donor kidney transplantations has increased considerably and nowadays outnumbers the deceased donor transplantations in our center. We investigated which socioeconomic and clinical factors influence who undergoes living or deceased donor kidney transplantation.


METHODS
This retrospective study included all 1338 patients who received a kidney transplant between 2000 and 2011 in the Erasmus MC Rotterdam. Clinical and socioeconomic variables were combined in our study. Clinical variables were recipient age, gender, ethnicity, original disease, retransplants, ABO blood type, panel-reactive antibody, previous treatment, and transplantation year. Each recipient's postcode was linked to a postcode area information data base, to extract demographic information on urbanization level, percentage non-Europeans in the area, income, and housing value. Chi-square, analysis of variance, and univariate and multivariate logistic regression analyses were performed.


RESULTS
There were significant differences between the recipients of a living versus deceased donor kidney transplantation. In multivariate logistic regression analyses, 10 variables had a significant influence on the chance of receiving living donor kidney transplantation. Clinical and socioeconomic factors had an independent influence on this chance. Patients with ABO blood type O and B have smaller chances. Highly sensitized and elderly patients have smaller chances especially when combined with a collection of other unfavorable factors. Accumulation of unfavorable factors in non-Europeans prevents their participation in living donation programs.


CONCLUSIONS
Both clinical and socioeconomic factors are associated with participation in living or deceased donor kidney transplantation. This study highlights the populations that would benefit from educational intervention regarding living donor transplantation.
Department of Internal Medicine, Erasmus MC Rotterdam, The Netherlands. J.Roodnat@erasmusmc.nl
Joke I
JI
Roodnat
Mirjam
M
Laging
Emma K
EK
Massey
Marcia
M
Kho
Judith A
JA
Kal-van Gestel
Jan N M
JN
Ijzermans
Jacqueline
J
van de Wetering
Willem
W
Weimar
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors / Q000600:supply & distribution*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010353:Patient Education as Topic; D018579:Patient Selection; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors