Renal Transplant Outcomes in Waitlist Candidates with a Previous Inactive Status Due to Being Temporarily Too Sick

Napat Leeaphorn, Marcelo S. Sampaio, Naowanit Natal, Alireza Mehrnia, Mandana Kamgar, Edmund Huang, Kamyar Kalantar-Zadeh, Bruce Kaplan, Suphamai Bunnapradist

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7).

METHODS: Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group). Patient and graft survival, 3-year risk of death, and graft failure were examined and compared.

RESULTS: After 3 years of follow-up, patient survival in the reason 7 group was significantly lower than that of the active group (88.14% versus 91.93%, p <0.01). The reason 7 group had a 20% increased risk of death (hazard ratio, HR 1.20, confidence interval, CI 1.04 - 1.38), a 16% increase in graft failure (HR 1.16, CI 1.06-1.28), and a 15% decrease in death-censored graft failure (HR 1.15, CI 1.01-1.31).

CONCLUSION: Recipients with a history of reason 7 have lower patient and graft survival when compared to the active group. Nonetheless, the margins of difference are minimal. Candidates with a history of reason 7 should not be discouraged from transplantation once they return to active status. Standardized criteria for placing candidates on inactive status should be developed to reduce disparities among transplant centers.

Original languageEnglish (US)
Pages (from-to)117-124
Number of pages8
JournalClinical transplants
StatePublished - 2014
Externally publishedYes

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Transplants
Kidney
Graft Survival
Tissue Donors
Transplantation
Databases
Confidence Intervals
Survival
Transplant Recipients

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Leeaphorn, N., Sampaio, M. S., Natal, N., Mehrnia, A., Kamgar, M., Huang, E., ... Bunnapradist, S. (2014). Renal Transplant Outcomes in Waitlist Candidates with a Previous Inactive Status Due to Being Temporarily Too Sick. Clinical transplants, 117-124.

Renal Transplant Outcomes in Waitlist Candidates with a Previous Inactive Status Due to Being Temporarily Too Sick. / Leeaphorn, Napat; Sampaio, Marcelo S.; Natal, Naowanit; Mehrnia, Alireza; Kamgar, Mandana; Huang, Edmund; Kalantar-Zadeh, Kamyar; Kaplan, Bruce; Bunnapradist, Suphamai.

In: Clinical transplants, 2014, p. 117-124.

Research output: Contribution to journalArticle

Leeaphorn, N, Sampaio, MS, Natal, N, Mehrnia, A, Kamgar, M, Huang, E, Kalantar-Zadeh, K, Kaplan, B & Bunnapradist, S 2014, 'Renal Transplant Outcomes in Waitlist Candidates with a Previous Inactive Status Due to Being Temporarily Too Sick', Clinical transplants, pp. 117-124.
Leeaphorn, Napat ; Sampaio, Marcelo S. ; Natal, Naowanit ; Mehrnia, Alireza ; Kamgar, Mandana ; Huang, Edmund ; Kalantar-Zadeh, Kamyar ; Kaplan, Bruce ; Bunnapradist, Suphamai. / Renal Transplant Outcomes in Waitlist Candidates with a Previous Inactive Status Due to Being Temporarily Too Sick. In: Clinical transplants. 2014 ; pp. 117-124.
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abstract = "BACKGROUND: In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7).METHODS: Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group). Patient and graft survival, 3-year risk of death, and graft failure were examined and compared.RESULTS: After 3 years of follow-up, patient survival in the reason 7 group was significantly lower than that of the active group (88.14{\%} versus 91.93{\%}, p <0.01). The reason 7 group had a 20{\%} increased risk of death (hazard ratio, HR 1.20, confidence interval, CI 1.04 - 1.38), a 16{\%} increase in graft failure (HR 1.16, CI 1.06-1.28), and a 15{\%} decrease in death-censored graft failure (HR 1.15, CI 1.01-1.31).CONCLUSION: Recipients with a history of reason 7 have lower patient and graft survival when compared to the active group. Nonetheless, the margins of difference are minimal. Candidates with a history of reason 7 should not be discouraged from transplantation once they return to active status. Standardized criteria for placing candidates on inactive status should be developed to reduce disparities among transplant centers.",
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AU - Leeaphorn, Napat

AU - Sampaio, Marcelo S.

AU - Natal, Naowanit

AU - Mehrnia, Alireza

AU - Kamgar, Mandana

AU - Huang, Edmund

AU - Kalantar-Zadeh, Kamyar

AU - Kaplan, Bruce

AU - Bunnapradist, Suphamai

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N2 - BACKGROUND: In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7).METHODS: Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group). Patient and graft survival, 3-year risk of death, and graft failure were examined and compared.RESULTS: After 3 years of follow-up, patient survival in the reason 7 group was significantly lower than that of the active group (88.14% versus 91.93%, p <0.01). The reason 7 group had a 20% increased risk of death (hazard ratio, HR 1.20, confidence interval, CI 1.04 - 1.38), a 16% increase in graft failure (HR 1.16, CI 1.06-1.28), and a 15% decrease in death-censored graft failure (HR 1.15, CI 1.01-1.31).CONCLUSION: Recipients with a history of reason 7 have lower patient and graft survival when compared to the active group. Nonetheless, the margins of difference are minimal. Candidates with a history of reason 7 should not be discouraged from transplantation once they return to active status. Standardized criteria for placing candidates on inactive status should be developed to reduce disparities among transplant centers.

AB - BACKGROUND: In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7).METHODS: Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group). Patient and graft survival, 3-year risk of death, and graft failure were examined and compared.RESULTS: After 3 years of follow-up, patient survival in the reason 7 group was significantly lower than that of the active group (88.14% versus 91.93%, p <0.01). The reason 7 group had a 20% increased risk of death (hazard ratio, HR 1.20, confidence interval, CI 1.04 - 1.38), a 16% increase in graft failure (HR 1.16, CI 1.06-1.28), and a 15% decrease in death-censored graft failure (HR 1.15, CI 1.01-1.31).CONCLUSION: Recipients with a history of reason 7 have lower patient and graft survival when compared to the active group. Nonetheless, the margins of difference are minimal. Candidates with a history of reason 7 should not be discouraged from transplantation once they return to active status. Standardized criteria for placing candidates on inactive status should be developed to reduce disparities among transplant centers.

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