Gomathy Parvathinathan, Suman Mohanty, Margaret Stedman, Kunyao Xu, Avi Dor, Itai Ashlagi, Xingxing S. Cheng
Introduction: Increasing access to kidney transplantation for patients with end-stage renal disease is a high priority in the United States. Recent policy changes to promote this include establishment of performance metrics examining the pretransplant performance of kidney transplant programs, but little is known about transplant program practices associated with these performance metrics. Our goal is to characterize waitlist attributes associated with the newly established pretransplant performance metrics at adult kidney transplant programs. Methods: We conducted a retrospective cohort analysis using completed case national data from the Scientific Registry of Transplant Recipients (SRTR). Exposures included deceased donor kidney waitlist attributes such as waitlist prevalence, waitlist incidence, percentage of incidence patients who are made status active, and transplant priority scores at key points including activation. Outcomes included pretransplant mortality rate ratio (PMRR) and organ acceptance rate ratio (OARR), as defined by the Organ Procurement Transplant Network (OPTN) Membership and Professional Standards Committee, for each transplant program-year. Results: Our study included 1268 transplant program-years from 2015 to 2020, representing 220 unique adult kidney transplant programs. Higher offer acceptance was associated with fewer patients on the waitlist (1.4% increase per every 100-patient decrease) and a higher percentage of patients receiving an offer within 90 days of activation (24.0% increase per 10% increase in the percent of patients receiving offers). Lower pretransplant mortality was associated with fewer patients on the waitlist (1.4% decrease per 100-patient decrease). Conclusion: A larger waitlist was associated with both higher pretransplant mortality and lower offer acceptance. Transplant programs behaviors underlying waitlist attributes associated with better or worse outcomes warrant additional investigation.