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Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors

Reed, Rhiannon D.1; MacLennan, Paul A. PhD1; Shelton, Brittany A.1; Mustian, Margaux N. MD1; Blackburn, Justin PhD2; Smith, Sharmene C.1; Terry, Kristin B.1; Grant, Raynesha1; Sawinski, Deirdre MD3; Locke, Jayme E. MD, FACS1

doi: 10.1097/TP.0000000000002508
Original Clinical Science—General
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Background. Living kidney donors in the United States who were obese at donation are at increased risk of end-stage renal disease and may benefit from intensive postdonation follow-up. However, they are less likely to have complete follow-up data. Center variation and risk factors for incomplete follow-up are unknown.

Methods. Adult living kidney donors with obesity (body mass index, ≥30 kg/m2) at donation reported to the Scientific Registry of Transplant Recipients from January 2005 to July 2015 were included (n = 13 831). Donor characteristics were compared by recorded serum creatinine at 6 months postdonation, and multilevel logistic regression models were used to estimate odds of 6-month creatinine.

Results. After adjustment, older age, female sex, and donation after implementation of new center follow-up requirements were associated with higher odds of 6-month creatinine, with lower odds for obese donors with a history of smoking, biologically related donors, and at centers with higher total living donor volume. 23% of variation in recorded 6-month serum creatinine among obese donors was attributed to center (intraclass correlation coefficient: 0.232, P < 0.001). The adjusted probability of 6-month creatinine by center ranged from 10% to 91.5%.

Conclusions. Tremendous variation in recorded 6-month postdonation serum creatinine exists among obese living donors, with high volume centers having the lowest probability of follow-up. Moreover, individual-level characteristics such as age, sex, and relationship to recipient were associated with recorded 6-month creatinine. Given increased risk for end-stage renal disease among obese living donors, center-level efforts targeted specifically at increasing postdonation follow-up among obese donors should be developed and implemented.

1 Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.

2 Department of Health Policy and Management, Indiana University-Purdue University Indianapolis, Indianapolis, IN.

3 Comprehensive Transplant Center, University of Pennsylvania, Philadelphia, PA.

Received 27 July 2018. Revision received 24 September 2018.

Accepted 12 October 2018.

These data were presented in preliminary form at the 2018 American Transplant Congress in Seattle, WA.

This project was supported by the National Institutes of Health (NIH)- National Institute of Diabetes and Digestive and Kidney Diseases, through Grant numbers K23-DK103918 (PI: Locke) and R01-DK113980 (PI: Locke).

The authors declare no conflicts of interest.

The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the SRTR or U.S. government.

R.D.R. and J.E.L. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. R.D.R. and J.E.L. conceived and designed the study. All authors participated in interpretation of the data, revision of the article, and gave final approval of the manuscript. R.D.R. and J.E.L. drafted the article. R.D.R. was responsible for the statistical analyses.

Correspondence: Jayme E. Locke, MD, FACS, 701 19th Street South, LHRB 748, Birmingham, AL 35294. (jlocke@uabmc.edu).

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