TY - JOUR
T1 - Leveraging marginal structural modeling with Cox regression to assess the survival benefit of accepting vs declining kidney allograft offers
AU - Cohen, Jordana B.
AU - Potluri, Vishnu
AU - Porrett, Paige M.
AU - Chen, Ruohui
AU - Roselli, Marielle
AU - Shults, Justine
AU - Sawinski, Deirdre L.
AU - Reese, Peter P.
N1 - Funding Information:
This research was supported in part by the National Institutes of Health grant number K23‐HL133843 (NHLBI, PI: Cohen). The inter‐ pretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or in‐ terpretation by the National Institutes of Health. The data reported here have been supplied by the United Network of Organ Sharing as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government.
Funding Information:
This research was supported in part by the National Institutes of Health grant number K23-HL133843 (NHLBI, PI: Cohen). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the National Institutes of Health. The data reported here have been supplied by the United Network of Organ Sharing as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government.
Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/7
Y1 - 2019/7
N2 - Existing studies evaluating the survival benefit of kidney transplantation were unable to incorporate time–updated information on decisions related to each organ offer. We used national registry data, including organ turndown data, to evaluate the survival benefit of accepting vs turning down kidney offers in candidates waitlisted from 2007-2013. Among candidates who declined their first offer, only 43% ultimately received organ transplantations. Recipients who later underwent organ transplantation after declining their first offer had markedly longer wait times than recipients who accepted their first offer, and 56% received kidney transplants that were of similar or lower quality compared to their initial offer. In marginal structural modeling analyses accounting for time-updated offer characteristics (including Kidney Donor Profile Index, Public Health System risk status, and pumping), after 3 months posttransplant, there was a significant survival benefit of accepting an offer (adjusted hazard ratio 0.76, 95% confidence interval 0.66-0.89) that was similar among diabetics, candidates aged >65 years, and candidates living in donor service areas with the longest waitlist times. After carefully accounting for the effect of donor quality, we confirm that the survival benefit of accepting an organ offer is clinically meaningful and persistent beyond 3 months post–kidney transplantation, including high-risk subgroups of organ transplantation candidates.
AB - Existing studies evaluating the survival benefit of kidney transplantation were unable to incorporate time–updated information on decisions related to each organ offer. We used national registry data, including organ turndown data, to evaluate the survival benefit of accepting vs turning down kidney offers in candidates waitlisted from 2007-2013. Among candidates who declined their first offer, only 43% ultimately received organ transplantations. Recipients who later underwent organ transplantation after declining their first offer had markedly longer wait times than recipients who accepted their first offer, and 56% received kidney transplants that were of similar or lower quality compared to their initial offer. In marginal structural modeling analyses accounting for time-updated offer characteristics (including Kidney Donor Profile Index, Public Health System risk status, and pumping), after 3 months posttransplant, there was a significant survival benefit of accepting an offer (adjusted hazard ratio 0.76, 95% confidence interval 0.66-0.89) that was similar among diabetics, candidates aged >65 years, and candidates living in donor service areas with the longest waitlist times. After carefully accounting for the effect of donor quality, we confirm that the survival benefit of accepting an organ offer is clinically meaningful and persistent beyond 3 months post–kidney transplantation, including high-risk subgroups of organ transplantation candidates.
KW - clinical research/practice
KW - donors and donation: deceased
KW - epidemiology
KW - kidney (allograft) function/dysfunction
KW - kidney transplantation/nephrology
KW - organ acceptance
KW - organ procurement and allocation
KW - patient survival
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U2 - 10.1111/ajt.15290
DO - 10.1111/ajt.15290
M3 - Article
C2 - 30725536
AN - SCOPUS:85062337511
SN - 1600-6135
VL - 19
SP - 1999
EP - 2008
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -
