Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Am J Transplant. 2017 Dec;17(12):3131-3140. doi: 10.1111/ajt.14356. Epub 2017 Jun 30.
In 2013, the Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS) mandated that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied Scientific Registry of Transplant Recipients data for 31,615 LKDs between January 2010 and June 2015, comparing proportions of complete and timely LDF form submissions before and after policy implementation. We also used multilevel logistic regression to assess donor- and center-level characteristics associated with complete and timely LDF submissions. Complete and timely 2-year LDF increased from 33% prepolicy (January 2010 through January 2013) to 54% postpolicy (February 2013 through June 2015) (p < 0.001). In an adjusted model, the odds of 2-year LDF increased by 22% per year prepolicy (p < 0.001) and 23% per year postpolicy (p < 0.001). Despite these annual increases in LDF, only 43% (87/202) of centers met the OPTN/UNOS-required 6-month, 1-year, and 2-year LDF thresholds for LKDs who donated in 2013. These findings motivate further evaluation of LDF barriers and the optimal approaches to capturing outcomes after living donation.
2013 年，器官获取与移植网络（OPTN）/器官共享联合网络（UNOS）要求移植中心在捐赠后 6 个月、1 年和 2 年收集活体肾脏供者（LKD）的数据，并规定了及时提交完整的活体供者随访（LDF）数据的比例政策界限（在预期访问日期之前或之后的 60 天内）。虽然有规定，但由于 LDF 在供者和中心层面存在潜在挑战，尚不清楚全国各中心在达到这些界限方面的表现如何。为了更好地了解该政策的影响，我们研究了 2010 年 1 月至 2015 年 6 月期间 31615 名 LKD 的 Scientific Registry of Transplant Recipients 数据，比较了政策实施前后完整和及时的 LDF 表格提交比例。我们还使用多水平逻辑回归评估了与完整和及时的 LDF 提交相关的供者和中心特征。完整和及时的 2 年 LDF 从政策前（2010 年 1 月至 2013 年 1 月）的 33%增加到政策后（2013 年 2 月至 2015 年 6 月）的 54%（p<0.001）。在调整后的模型中，每年的 LDF 比例增加 22%（p<0.001），每年的 LDF 比例增加 23%（p<0.001）。尽管 LDF 每年都在增加，但只有 43%（2013 年捐赠的 202 个中心中的 87 个）达到了 OPTN/UNOS 规定的 6 个月、1 年和 2 年 LKD 的 LDF 阈值。这些发现促使我们进一步评估 LDF 的障碍以及获取活体捐献后结果的最佳方法。
