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

Rhiannon D. Reed, Paul A. MacLennan, Brittany A. Shelton, Margaux N. Mustian, Justin Blackburn, Sharmene C. Smith, Kristin B. Terry, Raynesha Grant, Deirdre Sawinski, Jayme E. Locke

Research output: Contribution to journalArticle

Abstract

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/m) 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.

Original languageEnglish (US)
Pages (from-to)1450-1456
Number of pages7
JournalTransplantation
Volume103
Issue number7
DOIs
StatePublished - Jul 1 2019

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Living Donors
Creatinine
Kidney
Tissue Donors
Chronic Kidney Failure
Logistic Models
Serum
Social Adjustment
Registries
Body Mass Index
Obesity
Smoking

ASJC Scopus subject areas

  • Transplantation

Cite this

Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors. / Reed, Rhiannon D.; MacLennan, Paul A.; Shelton, Brittany A.; Mustian, Margaux N.; Blackburn, Justin; Smith, Sharmene C.; Terry, Kristin B.; Grant, Raynesha; Sawinski, Deirdre; Locke, Jayme E.

In: Transplantation, Vol. 103, No. 7, 01.07.2019, p. 1450-1456.

Research output: Contribution to journalArticle

Reed, RD, MacLennan, PA, Shelton, BA, Mustian, MN, Blackburn, J, Smith, SC, Terry, KB, Grant, R, Sawinski, D & Locke, JE 2019, 'Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors', Transplantation, vol. 103, no. 7, pp. 1450-1456. https://doi.org/10.1097/TP.0000000000002508
Reed, Rhiannon D. ; MacLennan, Paul A. ; Shelton, Brittany A. ; Mustian, Margaux N. ; Blackburn, Justin ; Smith, Sharmene C. ; Terry, Kristin B. ; Grant, Raynesha ; Sawinski, Deirdre ; Locke, Jayme E. / Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors. In: Transplantation. 2019 ; Vol. 103, No. 7. pp. 1450-1456.
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abstract = "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/m) 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.",
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T1 - Center Variation and Risk Factors for Failure to Complete 6 Month Postdonation Follow-up Among Obese Living Kidney Donors

AU - Reed, Rhiannon D.

AU - MacLennan, Paul A.

AU - Shelton, Brittany A.

AU - Mustian, Margaux N.

AU - Blackburn, Justin

AU - Smith, Sharmene C.

AU - Terry, Kristin B.

AU - Grant, Raynesha

AU - Sawinski, Deirdre

AU - Locke, Jayme E.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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/m) 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.

AB - 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/m) 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.

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