title: Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States.
abstract: Follow-up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow-up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow-up information by centers for 2 years. We utilized national SRTR data to evaluate donor and center-level factors associated with completed follow-up for donors 2008-2012 (n = 30 026) using multivariable hierarchical logistic models. We compared center follow-up compliance based on current UNOS standards using adjusted and unadjusted models. Complete follow-up at 6, 12, and 24 months was 67%, 60%, and 50% for clinical and 51%, 40%, and 30% for laboratory data, respectively, but have improved over time. Donor risk factors for missing laboratory data included younger age 18-34 (adjusted odds ratio [AOR] = 2.03, 1.58-2.60), black race (AOR = 1.17, 1.05-1.30), lack of insurance (AOR = 1.25, 1.15-1.36), lower educational attainment (AOR = 1.19, 1.06-1.34), >500 miles to center (AOR = 1.78, 1.60-1.98), and centers performing >40 living donor transplants/year (AOR = 2.20, 1.21-3.98). Risk-adjustment moderately shifted classification of center compliance with UNOS standards. There is substantial missing donor follow-up with marked variation by donor characteristics and centers. Although follow-up has improved over time, targeted efforts are needed for donors with selected characteristics and at centers with higher living donor volume. Adding adjustment for donor factors to policies regulating follow-up may function to provide more balanced evaluation of center efforts.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.|Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.|Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: L D
authors.initials: LD
authors.lastname: Buccini
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: J R
authors.initials: JR
authors.lastname: Rodrigue
authors.affiliation: University of Wisconsin, Madison, WI.
authors.forename: D
authors.initials: D
authors.lastname: Mandelbrot
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: D A
authors.initials: DA
authors.lastname: Goldfarb
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.|Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: S M
authors.initials: SM
authors.lastname: Flechner
authors.affiliation: Montefiore Medical Center, Bronx, NY.
authors.forename: L K
authors.initials: LK
authors.lastname: Kayler
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.|Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: E D
authors.initials: ED
authors.lastname: Poggio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000592:standards*; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006973:Hypertension; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012042:Registries; D009927:Tissue and Organ Procurement; D014481:United States; D055815:Young Adult
keywords: Donors and donation: donor follow-up; Scientific Registry for Transplant Recipients (SRTR); United Network for Organ Sharing (UNOS); kidney transplantation: living donor; risk assessment/risk stratification