http://onlinelibrary.wiley.com/doi/10.1111/ajt.13282/abstractCritical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States
J. D. Schold1,2,*, L. D. Buccini1,3, J. R. Rodrigue4, D. Mandelbrot5, D. A. Goldfarb6, S. M. Flechner2,6, L. K. Kayler7 andE. D. Poggio2,6
DOI: 10.1111/ajt.13282
American Journal of Transplantation
Abstract
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.