title: Association Between Organ Procurement Organization Social Network Centrality and Kidney Discard and Transplant Outcomes.
abstract: BACKGROUND
  Given growth in kidney transplant waitlists and discard rates, donor kidney acceptance is an important problem. We used network analysis to examine whether organ procurement organization (OPO) network centrality affects discard and outcomes.
  
  
  METHODS
  We identified 106,160 deceased donor kidneys recovered for transplant from 2000 to 2010 in Scientific Registry of Transplant Recipients. We constructed the transplant network by year with each OPO representing a node and each kidney-sharing relationship between OPOs representing a directed tie between nodes. Primary exposures were the number of different OPOs to which an OPO has given a kidney or from which an OPO has received a kidney in year preceding procurement year. Primary outcomes were discard, cold-ischemia time, delayed graft function, and 1-year graft loss. We used multivariable regression, restricting analysis to the 50% of OPOs with highest discard and stratifying remaining OPOs by kidney volume. Models controlled for kidney donor risk index, waitlist time, and kidney pumping.
  
  
  RESULTS
  An increase in one additional OPO to which a kidney was given by a procuring OPO in a year was associated with 1.4% lower likelihood of discard for a given kidney (odds ratio, 0.986; 95% confidence interval, 0.974-0.998) among OPOs procuring high kidney volume, but 2% higher likelihood of discard (odds ratio, 1.021; 95% confidence interval, 1.006-1.037) among OPOs procuring low kidney volume, with mixed associations with recipient outcomes.
  
  
  CONCLUSIONS
  Our study highlights the value of network analysis in revealing how broader kidney sharing is associated with levels of organ acceptance. We conclude interventions to promote broader inter-OPO sharing could be developed to reduce discard for a subset of OPOs.
authors.affiliation: 1 Department of Medicine, Massachusetts General Hospital, Boston, MA. 2 Yale School of Management, New Haven, CT. 3 NJ Sharing Network, New Providence, NJ. 4 Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, CT. 5 Division of Transplant Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA. 6 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. 7 Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA. 8 Program of Applied Translational Research, Department of Medicine, Yale School of Medicine, New Haven, CT. 9 Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT.
authors.forename: Neel M
authors.initials: NM
authors.lastname: Butala
authors.forename: Marissa D
authors.initials: MD
authors.lastname: King
authors.forename: William
authors.initials: W
authors.lastname: Reitsma
authors.forename: Richard N
authors.initials: RN
authors.lastname: Formica
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014850:Waiting Lists