First-Year Waitlist Hospitalization and Subsequent Waitlist and Transplant Outcome.
Frailty is associated with inferior survival and increased resource requirements among kidney transplant candidates, but assessments are time-intensive and costly and require direct patient interaction. Waitlist hospitalization may be a proxy for patient fitness and could help those at risk of poor outcomes. We examined United States Renal Data System data from 51 111 adult end-stage renal disease patients with continuous Medicare coverage who were waitlisted for transplant from January 2000 to December 2011. Heavily admitted patients had higher subsequent resource requirements, increased waitlist mortality and decreased likelihood of transplant (death after listing: 1-7 days: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.20-1.28; 8-14 days: HR 1.49, 95% CI 1.42-1.56; ≥15 days: HR 2.07, 95% CI 1.99-2.15; vs. 0 days). Graft and recipient survival was inferior, with higher admissions, although survival benefit was preserved. A model including waitlist admissions alone performed better (C statistic 0.76, 95% CI 0.74-0.80) in predicting postlisting mortality than estimated posttransplant survival (C statistic 0.69, 95% CI 0.67-0.73). Although those with a heavy burden of admissions may still benefit from kidney transplant, less utility is derived from allografts placed in this population. Current kidney allocation policy, which is based in part on longevity matching, could be significantly improved by consideration of hospitalization records of transplant candidates.
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
R J
RJ
Lynch
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA.
R
R
Zhang
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.|Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
R E
RE
Patzer
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
C P
CP
Larsen
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
A B
AB
Adams
D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014850:Waiting Lists
clinical decision-making; comorbidities; dialysis: complications; health services and outcomes research; kidney transplantation/nephrology; patient characteristics