Table 4.
Sensitivity analysis restricting the extensive pre-KAS time period and excluding potential 2015 bolus effects: unadjusted and adjusted associations with preemptive deceased donor transplantation, before KAS (2011–2013) and after KAS (2016–2018)
| Characteristic | Unadjusted | Adjusteda | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Pre-KAS | Post-KAS | P Value | Pre-KAS | Post-KAS | P Value | |||||
| OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | |||
| Race/ethnicity | ||||||||||
| White | Reference group | Reference group | Reference group | Reference group | ||||||
| Black | 0.31 | (0.28, 0.35) | 0.25 | (0.23, 0.28) | 0.004b | 0.50 | (0.45, 0.57) | 0.42 | (0.37, 0.47) | 0.004b |
| Hispanic | 0.30 | (0.26, 0.35) | 0.26 | (0.23, 0.29) | 0.09 | 0.46 | (0.40, 0.54) | 0.39 | (0.34, 0.45) | 0.10 |
| Other | 0.38 | (0.32, 0.45) | 0.39 | (0.33, 0.45) | 0.84 | 0.40 | (0.33, 0.48) | 0.44 | (0.38, 0.52) | 0.40 |
| Age at transplant | ||||||||||
| Yearsc | 1.26 | (1.22, 1.31) | 1.27 | (1.23, 1.31) | 0.80 | 1.87 | (1.77, 1.98) | 2.16 | (2.04, 2.29) | 0.05b |
| Sex | ||||||||||
| Male | Reference group | Reference group | Reference group | Reference group | ||||||
| Female | 1.51 | (1.40, 1.64) | 1.48 | (1.37, 1.60) | 0.69 | 1.55 | (1.41, 1.69) | 1.43 | (1.31, 1.56) | 0.11 |
| Education level | ||||||||||
| High school or less | Reference group | Reference group | Reference group | Reference group | ||||||
| Post-high school education | 1.64 | (1.50, 1.78) | 1.67 | (1.54, 1.82) | 0.70 | 1.22 | (1.11, 1.34) | 1.12 | (1.02, 1.23) | 0.71 |
| Unknown | 1.70 | (1.42, 2.05) | 2.53 | (2.09, 3.06) | 0.004b | 1.51 | (1.23, 1.84) | 1.77 | (1.43, 2.20) | 0.15 |
| Primary payer | ||||||||||
| Private | Reference group | Reference group | Reference group | Reference group | ||||||
| Medicare | 0.21 | (0.19, 0.23) | 0.18 | (0.16, 0.20) | 0.02b | 0.24 | (0.21, 0.26) | 0.20 | (0.18, 0.22) | 0.05 |
| Medicaid | 0.51 | (0.43, 0.62) | 0.39 | (0.33, 0.46) | 0.03b | 0.83 | (0.68, 1.02) | 0.71 | (0.60, 0.85) | 0.11 |
| Other/unknown | 0.51 | (0.39, 0.66) | 0.62 | (0.53, 0.71) | 0.22 | 0.57 | (0.44, 0.76) | 0.65 | (0.55, 0.77) | 0.29 |
| ESKD cause | ||||||||||
| GN | Reference group | Reference group | Reference group | Reference group | ||||||
| Diabetes | 0.55 | (0.44, 0.67) | 0.68 | (0.54, 0.87) | 0.17 | 0.55 | (0.42, 0.71) | 0.52 | (0.39, 0.69) | 0.22 |
| Hypertension | 0.64 | (0.52, 0.79) | 0.58 | (0.46, 0.75) | 0.59 | 0.76 | (0.61, 0.96) | 0.72 | (0.55, 0.94) | 0.75 |
| PCKD | 1.69 | (1.36, 2.10) | 2.16 | (1.68, 2.77) | 0.15 | 1.12 | (0.88, 1.42) | 1.34 | (1.02, 1.75) | 0.29 |
| Other/unknown | 1.35 | (1.10, 1.65) | 1.78 | (1.41, 2.25) | 0.07 | 1.31 | (1.05, 1.62) | 1.58 | (1.23, 2.03) | 0.22 |
| EPTS score at transplant | ||||||||||
| >20% or unknown | Reference group | Reference group | Reference group | Reference group | ||||||
| ≤20% (top 20) | 1.34 | (1.22, 1.46) | 1.45 | (1.33, 1.58) | 0.20 | 3.43 | (2.93, 4.01) | 4.94 | (4.20, 5.81) | 0.91 |
| KDPI score | ||||||||||
| ≤85%/unknown | Reference group | Reference group | Reference group | Reference group | ||||||
| >85% (high KDPI) | 0.78 | (0.68, 0.90) | 0.70 | (0.60, 0.82) | 0.30 | 0.74 | (0.64, 0.86) | 0.65 | (0.55, 0.78) | 0.48 |
| HLA mismatch | ||||||||||
| Nonzero MM/unknown | Reference group | Reference group | Reference group | Reference group | ||||||
| Zero mismatch | 1.83 | (1.60, 2.10) | 2.42 | (2.06, 2.83) | 0.009b | 1.40 | (1.21, 1.63) | 1.64 | (1.37, 1.96) | 0.15 |
| PRA sensitizationd | ||||||||||
| PRA <80% | Reference group | Reference group | Reference group | Reference group | ||||||
| PRA 80%–97% | 1.11 | (0.94, 1.31) | – | – | – | 0.89 | (0.74, 1.07) | – | – | – |
| PRA 98%–100% | 0.63 | (0.45, 0.89) | – | – | – | 0.58 | (0.40, 0.83) | – | – | – |
| Unknown | 1.83 | (1.57, 2.13) | 1.73 | (1.30, 2.28) | 0.72 | 1.34 | (1.13, 1.58) | 1.34 | (0.99, 1.81) | 0.92 |
| ABO blood type | ||||||||||
| O | Reference group | Reference group | Reference group | Reference group | ||||||
| A | 1.55 | (1.41, 1.69) | 1.50 | (1.37, 1.64) | 0.64 | 1.35 | (1.22, 1.48) | 1.17 | (1.06, 1.29) | 0.13 |
| B | 0.98 | (0.85, 1.12) | 1.12 | (0.99, 1.27) | 0.15 | 1.09 | (0.94, 1.26) | 1.20 | (1.04, 1.38) | 0.35 |
| AB | 1.83 | (1.56, 2.15) | 1.86 | (1.58, 2.19) | 0.87 | 1.71 | (1.44, 2.04) | 1.44 | (1.21, 1.73) | 0.27 |
| Diabetes | ||||||||||
| No | Reference group | Reference group | Reference group | Reference group | ||||||
| Yes | 0.62 | (0.57, 0.68) | 0.71 | (0.65, 0.77) | 0.04b | 1.20 | (1.03, 1.40) | 1.71 | (1.47, 1.98) | 0.009b |
| Transplant year | ||||||||||
| Additional year | 1.03 | (0.98, 1.08) | 1.14 | (1.08, 1.20) | 0.006b | 1.04 | (0.99, 1.10) | 1.04 | (0.98, 1.11) | 0.86 |
P value is for the interaction term between policy era and the characteristic. KAS, Kidney Allocation System; OR, odds ratio; 95% CI, 95% confidence interval; PCKD, polycystic kidney disease; EPTS, estimated post-transplant survival; KDPI, Kidney Donor Profile Index; HLA, Human Leukocyte Antigens; MM, mismatch; PRA, panel reactive antibody.
a
Adjusted model includes all predictors in this table.
b
Indicates statistical significance at the α = 0.05 level.
c
OR is for a 10-year increase in age.
d
Post-KAS PRA analyses could not be performed for this time range because of the extent of missing data.