Schold J D, Buccini L D, Rodrigue J R, Mandelbrot D, Goldfarb D A, Flechner S M, Kayler L K, Poggio E D
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
Am J Transplant. 2015 Sep;15(9):2394-403. doi: 10.1111/ajt.13282. Epub 2015 Apr 22.
Follow-up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow-up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow-up information by centers for 2 years. We utilized national SRTR data to evaluate donor and center-level factors associated with completed follow-up for donors 2008-2012 (n = 30 026) using multivariable hierarchical logistic models. We compared center follow-up compliance based on current UNOS standards using adjusted and unadjusted models. 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 18-34 (adjusted odds ratio [AOR] = 2.03, 1.58-2.60), black race (AOR = 1.17, 1.05-1.30), lack of insurance (AOR = 1.25, 1.15-1.36), lower educational attainment (AOR = 1.19, 1.06-1.34), >500 miles to center (AOR = 1.78, 1.60-1.98), and centers performing >40 living donor transplants/year (AOR = 2.20, 1.21-3.98). Risk-adjustment moderately shifted classification of center compliance with UNOS standards. There is substantial missing donor follow-up with marked variation by donor characteristics and centers. Although follow-up has improved over time, targeted efforts are needed for donors with selected characteristics and at centers with higher living donor volume. Adding adjustment for donor factors to policies regulating follow-up may function to provide more balanced evaluation of center efforts.
对活体肾供者的随访护理是移植界的一项重要职责。先前的报告表明供者随访信息不完整，这可能反映了供者和移植中心两方面的因素。器官共享联合网络（UNOS）的新规定要求各中心报告供者两年的随访信息。我们利用国家器官获取与移植受者科学注册系统（SRTR）的数据，采用多变量分层逻辑模型评估2008 - 2012年供者（n = 30026）完成随访的供者和中心层面因素。我们使用调整和未调整模型，根据当前UNOS标准比较中心的随访依从性。临床随访在6个月、12个月和24个月时的完整率分别为67%、60%和50%，实验室数据的完整率分别为51%、40%和30%，但随时间有所改善。实验室数据缺失的供者风险因素包括年龄18 - 34岁（调整比值比[AOR]=2.03，1.58 - 2.60）、黑人种族（AOR = 1.17，1.05 - 1.30）、无保险（AOR = 1.25，1.15 - 1.36）、教育程度较低（AOR = 1.19，1.06 - 1.34）、距离中心超过500英里（AOR = 1.78，1.60 - 1.98）以及每年进行超过40例活体供者移植的中心（AOR = 2.20，1.21 - 3.98）。风险调整适度改变了中心符合UNOS标准的分类。供者随访存在大量缺失，且因供者特征和中心不同而有显著差异。尽管随访情况随时间有所改善，但对于具有特定特征的供者以及活体供者数量较多的中心，仍需要有针对性的努力。在规范随访的政策中加入对供者因素的调整，可能有助于对中心工作进行更平衡的评估。
