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January 8, 1992

Factors Affecting the Waiting Time of Cadaveric Kidney Transplant Candidates in the United States

Author Affiliations

From the Departments of Pathology, Microbiology and Immunology, and Surgery, Duke University and Veterans Affairs Medical Centers, Durham, NC (Dr Sanfilippo); the Department of Research, United Network for Organ Sharing, Richmond, Va (Dr Vaughn); the Department of Surgery, Methodist Medical Center, Jacksonville, Fla (Dr Peters); the Department of Surgery, St Francis Regional Medical Center, Wichita, Kan (Dr Shield); the Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Adams); the Department of Surgery, Yale University School of Medicine, New Haven, Conn (Dr Lorber); and the Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Md (Dr Williams). Dr Vaughn is now with the Texas Heart Institute, Houston.

JAMA. 1992;267(2):247-252. doi:10.1001/jama.1992.03480020057031

Objective.  —To evaluate the relative impact of various factors that could account for differences in waiting time of cadaveric kidney transplant candidates (eg, black and sensitized patients).

Design.  —A cohort study using multivariate analyses to identify associations between 36 patient, donor, and center factors with waiting time for all US cadaveric kidney transplant candidates listed between October 1, 1987, and June 30, 1990.

Setting.  —All US kidney transplant centers.

Patients.  —The study included 23468 cadaveric renal transplant candidates on active waiting status.

Results.  —The patient characteristics most significantly associated with increased waiting time (adjusted for all other variables) were immunologic and included presensitization to HLA antigens, O or B blood type, candidacy for a repeat transplantation, and expression of rare HLA-A or HLA-B antigen phenotypes. Nonimmunologic factors also affected waiting times, which were significantly shorter for patients younger than 15 years vs those aged 15 through 44 years (8.4 vs 12.9 months, respectively; P<.0001), for those listed at multiple centers vs one center (7.0 vs 13.3 months, respectively;P<.0001), or for white vs black patients (11.9 vs 15.4 months, respectively;P<.0001). Local transplant center characteristics associated with a significantly shorter waiting time included a small number of transplantation candidates, a high (>35 per million population) local kidney organ recovery rate, and an approved variance from the Organ Procurement and Transplantation Network allocation algorithm.

Conclusions.  —The time renal transplant candidates must wait for kidney transplantation is influenced by several factors in addition to those expected due to immunologic reasons of donor incompatibility, the algorithms used for organ distribution, or the effectiveness of local kidney recovery. The impact of these factors should be considered as the current US system for allocating scarce donor organs for kidney transplantation is modified.(JAMA. 1992;267:247-252)