Critical Factors Associated With Missing Follow‐Up Data for Living Kidney Donors in the United States

Follow‐up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow‐up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow‐up information by cent...

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Bibliographic Details
Published in:American journal of transplantation 2015-09, Vol.15 (9), p.2394-2403
Main Authors: Schold, J. D., Buccini, L. D., Rodrigue, J. R., Mandelbrot, D., Goldfarb, D. A., Flechner, S. M., Kayler, L. K., Poggio, E. D.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Compliance
Continuity of Patient Care - standards
Delivery of Health Care
Donors and donation: donor follow‐up
Female
Follow-Up Studies
Guideline Adherence - standards
Humans
Hypertension
Kidney Transplantation
kidney transplantation: living donor
Laboratories
Living Donors
Male
Middle Aged
Registries
risk assessment/risk stratification
Scientific Registry for Transplant Recipients (SRTR)
Tissue and Organ Procurement
Transplants & implants
United Network for Organ Sharing (UNOS)
United States
Young Adult
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Summary:Follow‐up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow‐up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow‐up information by centers for 2 years. We utilized national SRTR data to evaluate donor and center‐level factors associated with completed follow‐up for donors 2008–2012 (n = 30 026) using multivariable hierarchical logistic models. We compared center follow‐up compliance based on current UNOS standards using adjusted and unadjusted models. Complete follow‐up at 6, 12, and 24 months was 67%, 60%, and 50% for clinical and 51%, 40%, and 30% for laboratory data, respectively, but have improved over time. Donor risk factors for missing laboratory data included younger age 18–34 (adjusted odds ratio [AOR] = 2.03, 1.58–2.60), black race (AOR = 1.17, 1.05–1.30), lack of insurance (AOR = 1.25, 1.15–1.36), lower educational attainment (AOR = 1.19, 1.06–1.34), >500 miles to center (AOR = 1.78, 1.60–1.98), and centers performing >40 living donor transplants/year (AOR = 2.20, 1.21–3.98). Risk‐adjustment moderately shifted classification of center compliance with UNOS standards. There is substantial missing donor follow‐up with marked variation by donor characteristics and centers. Although follow‐up has improved over time, targeted efforts are needed for donors with selected characteristics and at centers with higher living donor volume. Adding adjustment for donor factors to policies regulating follow‐up may function to provide more balanced evaluation of center efforts. This study demonstrates significant variation in living kidney donor follow‐up information explained by donor characteristics and individual transplant centers that has important implications for interventions to improve follow‐up as well as for evaluating center compliance with UNOS regulations.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.13282