Table 2.
Characteristics of preemptive deceased donor kidney transplants, pre-KAS (2000–2013) and post-KAS (2015–2018)
| Characteristic | Total Transplants | Preemptive Transplants n (% Preemptive) |
Absolute Difference in % Preemptive or Age (post-KAS - pre-KAS) | Adjusted Odds Ratio (95% CI) of Preemptive Transplantation | Interaction Term P Value | |||
|---|---|---|---|---|---|---|---|---|
| Pre-KAS | Post-KAS | Pre-KAS | Post-KAS | Pre-KAS | Post-KAS | |||
| Race/ethnicity | ||||||||
| White | 50,487 | 13,120 | 7072 (14%) | 2322 (18%) | 3.69 | Reference group | Reference group | |
| Black | 35,870 | 12,817 | 1721 (5%) | 629 (5%) | 0.11 | 0.48 (0.45, 0.51) | 0.41 (0.37, 0.45) | <0.001a |
| Hispanic | 15,998 | 7073 | 734 (5%) | 381 (5%) | 0.80 | 0.43 (0.40, 0.47) | 0.40 (0.36, 0.46) | 0.04a |
| Other | 8798 | 3574 | 518 (6%) | 271 (8%) | 1.69 | 0.43 (0.39, 0.47) | 0.44 (0.38, 0.51) | 0.99 |
| Age at transplant | ||||||||
| Yearsb | 111,153 | 36,584 | 55 (±12)c | 57 (±12)c | 1.93 | 1.69 (1.64, 1.74) | 2.09 (1.99, 2.20) | <0.001a |
| Sex | ||||||||
| Male | 67,491 | 21,961 | 5392 (8%) | 1880 (9%) | 0.57 | Reference group | Reference group | |
| Female | 43,662 | 14,623 | 4653 (11%) | 1723 (12%) | 1.12 | 1.41 (1.35, 1.48) | 1.37 (1.27, 1.48) | 0.52 |
| Education level | ||||||||
| High school or less | 3789 | 18,270 | 3789 (7%) | 1354 (7%) | 0.31 | Reference group | Reference group | |
| Post-high school education | 4662 | 17,230 | 4662 (11%) | 2059 (12%) | 0.93 | 1.20 (1.14, 1.26) | 1.16 (1.07, 1.25) | 0.57 |
| Unknown | 1594 | 1084 | 1594 (10%) | 190 (18%) | 7.23 | 1.42 (1.33, 1.51) | 1.73 (1.44, 2.09) | 0.01a |
| Primary payer | ||||||||
| Private | 31,946 | 7317 | 5903 (18%) | 1768 (24%) | 5.68 | Reference group | Reference group | |
| Medicare | 71,803 | 25,020 | 3370 (5%) | 1289 (5%) | 0.46 | 0.26 (0.25, 0.27) | 0.20 (0.18, 0.22) | <0.001a |
| Medicaid | 5410 | 2426 | 498 (9%) | 257 (11%) | 1.38 | 0.71 (0.64, 0.78) | 0.67 (0.57, 0.78) | 0.12 |
| Other/unknown | 1994 | 1821 | 274 (14%) | 289 (16%) | 2.13 | 0.81 (0.71, 0.93) | 0.62 (0.53, 0.73) | 0.02a |
| ESKD cause | ||||||||
| GN | 6432 | 1251 | 573 (9%) | 112 (9%) | 0.04 | Reference group | Reference group | |
| Diabetes | 30,386 | 10,922 | 1890 (6%) | 691 (6%) | 0.11 | 0.62 (0.55, 0.71) | 0.52 (0.40, 0.67) | 0.96 |
| Hypertension | 28,419 | 9420 | 1741 (6%) | 514 (5%) | −0.67 | 0.83 (0.74, 0.92) | 0.73 (0.58, 0.92) | 0.35 |
| PCKD | 9990 | 2746 | 1640 (16%) | 487 (18%) | 1.31 | 1.30 (1.17, 1.45) | 1.32 (1.05, 1.67) | 0.61 |
| Other/unknown | 35,926 | 12,245 | 4201 (12%) | 1799 (15%) | 3.00 | 1.24 (1.12, 1.36) | 1.54 (1.24, 1.91) | 0.08 |
| EPTS score at transplant | ||||||||
| >20% or unknown | 80,910 | 27,237 | 6507 (8%) | 2444 (9%) | 0.93 | Reference group | Reference group | |
| ≤20% (top 20) | 30,243 | 9347 | 3538 (12%) | 1159 (12%) | 0.70 | 3.72 (3.45, 4.01) | 4.69 (4.07, 5.40) | 0.02a |
| KDPI score | ||||||||
| ≤85%/unknown | 98,564 | 33,336 | 9110 (9%) | 3371 (10%) | 0.87 | Reference group | Reference group | |
| >85% (high KDPI) | 12,589 | 3248 | 935 (7%) | 232 (7%) | −0.29 | 0.81 (0.75, 0.87) | 0.66 (0.57, 0.76) | 0.16 |
| HLA mismatch | ||||||||
| Nonzero MM/unknown | 99,194 | 35,237 | 8306 (8%) | 3330 (9%) | 1.08 | Reference group | Reference group | |
| Zero mismatch | 11,959 | 1347 | 1739 (15%) | 273 (20%) | 5.73 | 1.47 (1.39, 1.57) | 1.55 (1.33, 1.81) | 0.41 |
| PRA sensitization | ||||||||
| PRA <80% | 100,057 | 2650 | 8845 (9%) | 172 (6%) | −2.35 | Reference group | Reference group | |
| PRA 80%–97% | 6248 | 170 | 529 (8%) | 14 (8%) | −0.23 | 0.85 (0.77, 0.94) | 1.10 (0.59, 2.08) | 0.50 |
| PRA 98%–100% | 2756 | 164 | 192 (7%) | 7 (4%) | −2.70 | 0.73 (0.62, 0.85) | 0.54 (0.24, 1.22) | 0.46 |
| Unknown | 2092 | 33,600 | 479 (23%) | 3410 (10%) | −12.75 | 2.12 (1.89, 2.38) | 1.22 (1.03, 1.46) | <0.001a |
| ABO blood type | ||||||||
| O | 50,025 | 16,560 | 3842 (8%) | 1336 (8%) | 0.39 | Reference group | Reference group | |
| A | 40,448 | 12,873 | 4300 (11%) | 1512 (12%) | 1.12 | 1.21 (1.15, 1.27) | 1.17 (1.08, 1.28) | 0.93 |
| B | 14,731 | 5171 | 1131 (8%) | 468 (9%) | 1.37 | 1.11 (1.03, 1.20) | 1.20 (1.06, 1.35) | 0.35 |
| AB | 5949 | 1980 | 772 (13%) | 287 (14%) | 1.51 | 1.62 (1.49, 1.78) | 1.53 (1.31, 1.78) | 0.55 |
| Diabetes | ||||||||
| No/unknown | 72,410 | 22,865 | 7264 (10%) | 2499 (11%) | 0.90 | Reference group | Reference group | |
| Yes | 38,743 | 13,719 | 2781 (7%) | 1104 (8%) | 0.87 | 1.43 (1.32, 1.55) | 1.67 (1.47, 1.90) | 0.97 |
| Transplant year | ||||||||
| Additional year | 111,153 | 36,584 | 1.04 (1.03, 1.05) | 1.04 (1.00, 1.09) | 0.43 | |||
| Total (era row %) | 111,153 | 36,584 | 10,045 (9.0%) | 3603 (9.8%) | 0.81 | |||
Percentages presented in the table are row percentages (% preemptive in each era). “Absolute difference in % preemptive or age” was calculated by subtracting the percentage of transplants occurring preemptively in the pre-KAS era from the percentage occurring preemptively in the post-KAS era, or the pre-KAS mean age from the post-KAS mean age. A positive value indicates a greater proportion of transplants occurred preemptively for this subgroup after implementation of KAS, and a negative value indicates the proportion decreased after KAS. Adjusted model includes all characteristics in this table. P value is for interaction term between policy era and the characteristic. KAS, Kidney Allocation System; 95% CI, 95% confidence interval; PCKD, polycystic kidney disease; EPTS, estimated post-transplant survival; KDPI, Kidney Donor Profile Index; HLA, Human Leukocyte Antigen; MM, mismatch; PRA, panel reactive antibody.
Indicates statistical significance at the α = 0.05 level.
Odds ratio is for a 10-year increase in age.
Value presented for age is mean (±SD).