Trends in the Inactive Kidney Transplant Waitlist and Implications for Candidate Survival
In November 2003, OPTN policy was amended to allow kidney transplant candidates to accrue waiting time while registered as status 7, or inactive. We evaluated trends in inactive listings and the association of inactive status with transplantation and survival, studying 262 824 adult first‐time KT ca...
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| Veröffentlicht in: | American journal of transplantation 2013-04, Vol.13 (4), p.1012-1018 |
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| container_title | American journal of transplantation |
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| creator | Grams, M. E. Massie, A. B. Schold, J. D. Chen, B. P. Segev, D. L. |
| description | In November 2003, OPTN policy was amended to allow kidney transplant candidates to accrue waiting time while registered as status 7, or inactive. We evaluated trends in inactive listings and the association of inactive status with transplantation and survival, studying 262 824 adult first‐time KT candidates listed between 2000 and 2011. The proportion of waitlist candidates initially listed as inactive increased from 2.3% prepolicy change to 31.4% in 2011. Candidates initially listed as inactive were older, more often female, African American, and with higher body mass index. Postpolicy change, conversion from initially inactive to active status generally occurred early if at all: at 1 year after listing, 52.7% of initially inactive candidates had been activated; at 3 years, only 66.3% had been activated. Inactive status was associated with a substantially higher waitlist mortality (aHR 2.21, 95%CI:2.15–2.28, p |
| doi_str_mv | 10.1111/ajt.12143 |
| format | Article |
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Since the amendment to OPTN policy 3.5.11, an increasing proportion of kidney transplant waitlist candidates are listed as inactive, and these candidates have higher mortality and lower transplant rates than those with an active status.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.12143</identifier><identifier>PMID: 23399028</identifier><language>eng</language><publisher>Hoboken, NJ: Wiley</publisher><subject>Adult ; Biological and medical sciences ; Body Mass Index ; Deceased donor ; Female ; Health Policy ; Humans ; inactive status ; kidney transplantation ; Kidney Transplantation - legislation & jurisprudence ; Kidney Transplantation - trends ; Male ; Medical sciences ; Middle Aged ; Phenotype ; Registries ; Renal Insufficiency - mortality ; Renal Insufficiency - therapy ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Survival Rate ; Time Factors ; Tissue and Organ Procurement - statistics & numerical data ; Treatment Outcome ; United States ; Waiting Lists ; waitlist</subject><ispartof>American journal of transplantation, 2013-04, Vol.13 (4), p.1012-1018</ispartof><rights>Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2014 INIST-CNRS</rights><rights>Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><rights>2013 American Society of Transplantation and the American Society of Transplant Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6053-70f0d29aa2931c570ffc24834387fa3c3029c1e83e0400b83a89824deb55b8583</citedby><cites>FETCH-LOGICAL-c6053-70f0d29aa2931c570ffc24834387fa3c3029c1e83e0400b83a89824deb55b8583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.12143$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.12143$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27423218$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23399028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grams, M. E.</creatorcontrib><creatorcontrib>Massie, A. B.</creatorcontrib><creatorcontrib>Schold, J. D.</creatorcontrib><creatorcontrib>Chen, B. P.</creatorcontrib><creatorcontrib>Segev, D. L.</creatorcontrib><title>Trends in the Inactive Kidney Transplant Waitlist and Implications for Candidate Survival</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>In November 2003, OPTN policy was amended to allow kidney transplant candidates to accrue waiting time while registered as status 7, or inactive. We evaluated trends in inactive listings and the association of inactive status with transplantation and survival, studying 262 824 adult first‐time KT candidates listed between 2000 and 2011. The proportion of waitlist candidates initially listed as inactive increased from 2.3% prepolicy change to 31.4% in 2011. Candidates initially listed as inactive were older, more often female, African American, and with higher body mass index. Postpolicy change, conversion from initially inactive to active status generally occurred early if at all: at 1 year after listing, 52.7% of initially inactive candidates had been activated; at 3 years, only 66.3% had been activated. Inactive status was associated with a substantially higher waitlist mortality (aHR 2.21, 95%CI:2.15–2.28, p < 0.001) and lower rates of eventual transplantation (aRR 0.68, 95%CI:0.67–0.70, p < 0.001). In summary, waitlist practice has changed significantly since November 2003, with a sharp increase in the number of inactive candidates. Using the full waitlist to estimate organ shortage or as a comparison group in transplant outcome studies is less appropriate in the current era.
Since the amendment to OPTN policy 3.5.11, an increasing proportion of kidney transplant waitlist candidates are listed as inactive, and these candidates have higher mortality and lower transplant rates than those with an active status.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Deceased donor</subject><subject>Female</subject><subject>Health Policy</subject><subject>Humans</subject><subject>inactive status</subject><subject>kidney transplantation</subject><subject>Kidney Transplantation - legislation & jurisprudence</subject><subject>Kidney Transplantation - trends</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Phenotype</subject><subject>Registries</subject><subject>Renal Insufficiency - mortality</subject><subject>Renal Insufficiency - therapy</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Tissue and Organ Procurement - statistics & numerical data</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Waiting Lists</subject><subject>waitlist</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtrGzEUhUVJqZO0i_yBIAiBdOFEr5nRbALG9OHG0EVdSlfiWqNJZGSNI2lc_O8r167bBkK10ZX0cc69OgidUXJN87qBRbqmjAr-Ah3TkpBhmeujQ82LATqJcUEIrZhkr9CAcV7XhMlj9H0WjG8ith6nB4MnHnSya4PvbOPNBs8C-Lhy4BP-BjY5GxMG3-DJcuWshmQ7H3HbBTzOt7aBZPCXPqztGtxr9LIFF82b_X6Kvr5_Nxt_HE4_f5iMR9OhLknBhxVpScNqAFZzqot8bDUTkgsuqxa45oTVmhrJDRGEzCUHWUsmGjMvirksJD9FtzvdVT9fmkYbnwI4tQp2CWGjOrDq3xdvH9R9t1Zc1qwmIgtc7QVC99ibmNTSRm1cntp0fVS0kgXjQgryf5Sz3LegtMroxRN00fXB55_YUrSkFS231NsdpUMXYzDtoW9K1DZblbNVv7LN7Pnfgx7I32Fm4HIPQNTg2pydtvEPVwmWnbfczY77YZ3ZPO-oRp9mO-uf_Nu5lQ</recordid><startdate>201304</startdate><enddate>201304</enddate><creator>Grams, M. E.</creator><creator>Massie, A. B.</creator><creator>Schold, J. D.</creator><creator>Chen, B. P.</creator><creator>Segev, D. L.</creator><general>Wiley</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201304</creationdate><title>Trends in the Inactive Kidney Transplant Waitlist and Implications for Candidate Survival</title><author>Grams, M. E. ; Massie, A. B. ; Schold, J. D. ; Chen, B. P. ; Segev, D. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6053-70f0d29aa2931c570ffc24834387fa3c3029c1e83e0400b83a89824deb55b8583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Deceased donor</topic><topic>Female</topic><topic>Health Policy</topic><topic>Humans</topic><topic>inactive status</topic><topic>kidney transplantation</topic><topic>Kidney Transplantation - legislation & jurisprudence</topic><topic>Kidney Transplantation - trends</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Phenotype</topic><topic>Registries</topic><topic>Renal Insufficiency - mortality</topic><topic>Renal Insufficiency - therapy</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Tissue and Organ Procurement - statistics & numerical data</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Waiting Lists</topic><topic>waitlist</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grams, M. E.</creatorcontrib><creatorcontrib>Massie, A. B.</creatorcontrib><creatorcontrib>Schold, J. D.</creatorcontrib><creatorcontrib>Chen, B. P.</creatorcontrib><creatorcontrib>Segev, D. L.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grams, M. E.</au><au>Massie, A. B.</au><au>Schold, J. D.</au><au>Chen, B. P.</au><au>Segev, D. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in the Inactive Kidney Transplant Waitlist and Implications for Candidate Survival</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2013-04</date><risdate>2013</risdate><volume>13</volume><issue>4</issue><spage>1012</spage><epage>1018</epage><pages>1012-1018</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>In November 2003, OPTN policy was amended to allow kidney transplant candidates to accrue waiting time while registered as status 7, or inactive. We evaluated trends in inactive listings and the association of inactive status with transplantation and survival, studying 262 824 adult first‐time KT candidates listed between 2000 and 2011. The proportion of waitlist candidates initially listed as inactive increased from 2.3% prepolicy change to 31.4% in 2011. Candidates initially listed as inactive were older, more often female, African American, and with higher body mass index. Postpolicy change, conversion from initially inactive to active status generally occurred early if at all: at 1 year after listing, 52.7% of initially inactive candidates had been activated; at 3 years, only 66.3% had been activated. Inactive status was associated with a substantially higher waitlist mortality (aHR 2.21, 95%CI:2.15–2.28, p < 0.001) and lower rates of eventual transplantation (aRR 0.68, 95%CI:0.67–0.70, p < 0.001). In summary, waitlist practice has changed significantly since November 2003, with a sharp increase in the number of inactive candidates. Using the full waitlist to estimate organ shortage or as a comparison group in transplant outcome studies is less appropriate in the current era.
Since the amendment to OPTN policy 3.5.11, an increasing proportion of kidney transplant waitlist candidates are listed as inactive, and these candidates have higher mortality and lower transplant rates than those with an active status.</abstract><cop>Hoboken, NJ</cop><pub>Wiley</pub><pmid>23399028</pmid><doi>10.1111/ajt.12143</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Biological and medical sciences Body Mass Index Deceased donor Female Health Policy Humans inactive status kidney transplantation Kidney Transplantation - legislation & jurisprudence Kidney Transplantation - trends Male Medical sciences Middle Aged Phenotype Registries Renal Insufficiency - mortality Renal Insufficiency - therapy Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Survival Rate Time Factors Tissue and Organ Procurement - statistics & numerical data Treatment Outcome United States Waiting Lists waitlist |
| title | Trends in the Inactive Kidney Transplant Waitlist and Implications for Candidate Survival |
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