Physician Preferences when Selecting Candidates for Lower-Quality Kidney Offers

Juan M. Gonzalez Sepulveda, Sanjay Mehrotra, Jui Chen Yang, Karolina J. Schantz, Yolanda Becker, Richard Formica, Daniela P. Ladner, Dixon Kaufman, John Friedewald

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background In the United States, more than 50% of kidneys in the lowest 15% quality range (those with Kidney Donor Profile Index .85) are discarded. Studies suggest that using more of these kidneys could benefit patients waiting for a transplant. This study assesses the trade-offs physicians make when selecting recipients for lower-quality kidneys. Methods A discrete choice experiment (DCE) was administered to surgeons and nephrologists in the United States who are involved in kidney acceptance decisions. The DCE presented kidneys that varied in terms of Kidney Donor Profile Index, expected cold ischemia time, donor age, pump parameters, serum creatinine levels, glomerulosclerosis, donor diabetes status, and whether donation was made after circulatory death. Candidate characteristics included recipients’ age, diabetes history, time on dialysis, ejection fraction, HLA mismatch, calculated panel reactive antibody, and Karnofsky performance score. Regression analysis was used to estimate acceptability weights associated with kidney and recipient characteristics. Results A total of 108 physicians completed the DCE. The likelihood of acceptance was significantly lower with deterioration of kidney quality, expected cold ischemia time at transplantation, and missing biopsy and pump information. Acceptance was prioritized for patients who were higher on the waiting list, younger recipients, those who have spent less time on dialysis, and those without a history of diabetes. Performance status (Karnofsky score) and calculated panel reactive antibody also had a statistically significant but smaller association. Finally, ejection fraction had a marginally significant association, and HLA match had no significant association with the acceptance of marginal kidneys. A group of respondents were found to be primarily concerned about cold ischemia time. Conclusions In this DCE, physicians considered the recipient characteristics that inform expected post-transplant survival score when they decided whether to accept a marginal kidney for a given recipient.

Original languageEnglish (US)
Pages (from-to)1599-1609
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume18
Issue number12
DOIs
StatePublished - Dec 2023

Funding

S. Mehrotra: National Institutes of Health (1R01DK118425-01A1). Because Dr. Richard Formica is an Associate Editor of CJASN, he was not involved in the peer-review process for this manuscript. Another editor oversaw the peer-review and decision-making process for this manuscript.

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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