The Association of Community Health Indicators With Outcomes for Kidney Transplant Recipients in the United States

The Association of Center Performance Evaluations and Kidney Transplant Volume in the United States

“…There may be some evidence to suggest that changes in practice could enhance performance evaluations independent of actual changes in quality of care. There are data indicating that models utilized for risk adjustment for the program-specific reports have limited predictive capacity suggesting that factors not included in the models affect outcomes and could potentially vary between centers (19,20). As such, limiting transplants based on risk factors not captured in the models may improve measured performance of centers.…”

Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States

“…We also evaluated the association of community risk score which has been described in prior studies and shown to be significantly associated with transplant candidate and recipient outcomes (24,25). Finally, we examined the impact of center-level factors on the proportion of complete living donor follow-up information including centers' annual number of living donor transplants and the proportion of kidney transplants at centers from living donors relative to the combination of living and deceased donors.…”

“…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][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] (adjusted odds ratio [AOR] ¼ 2.03, 1.58-2.60), black race (AOR ¼ 1.17, 1.05-1.30), lack of insurance (AOR ¼ 1.25, 1.15-1.36), lower educational attainment (AOR ¼ 1.19, 1.06-1.34), >500 miles to center (AOR ¼ 1.78, 1.60-1.98), and centers performing >40 living donor transplants/year (AOR ¼ 2.20, 1.21-3.98). Risk-adjustment moderately shifted classification of center compliance with UNOS standards.…”

Prominent Impact of Community Risk Factors on Kidney Transplant Candidate Processes and Outcomes

“…The data characterize communities based on access and quality of care, prevalence of comorbid conditions, environmental hazards and behavioral attributes of individuals within counties. Based on these data, in a prior study, kidney transplant recipients from highest risk communities had 26% increased hazard for post-transplant mortality independent of known patient, donor and clinical risk factors (15). These results along with emerging evidence in a variety of healthcare contexts suggests that conditions in patients’ communities are highly influential factors associated with patient outcomes.…”