期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 23, 期 2, 页码 223-231出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajt.2022.12.005
关键词
ethics and public policy; health services and outcomes research; kidney transplantation; nephrology; organ allocation; Organ Procurement and Transplantation; Network (OPTN); patient characteristics; statistics; waitlist management
We estimated the median waiting time for kidney transplant in the United States using different methods and timeframes. The overall median waiting time decreased to 5.19 years between 2015 and 2018 and further declined to 4.05 years from April 2021 to March 2022. There were significant differences in median waiting times based on blood type, donor service area, and pediatric vs adult status, but less variation by race/ethnicity. We recommend using the period-prevalent Kaplan-Meier approach in addition to the competing risks approach to address the lack of information on kidney transplant waiting times.
The median waiting time (MWT) to deceased donor kidney transplant is of interest to patients, clinicians, and the media but remains elusive due to both methodological and philosophical challenges. We used Organ Procurement and Transplantation Network data from January 2003 to March 2022 to estimate MWTs using various methods and timescales, applied overall, by era, and by candidate demographics. After rising for a decade, the overall MWT fell to 5.19 years between 2015 and 2018 and declined again to 4.05 years (April 2021 to March 2022), based on the Kaplan-Meier method applied to period-prevalent cohorts. MWTs differed markedly by blood type, donor service area, and pediatric vs adult status, but to a lesser degree by race/ethnicity. Choice of methodology affected the magnitude of these differences. Instead of waiting years for an answer, reliable kidney MWT estimates can be obtained shortly after a policy is implemented using the period-prevalent Kaplan-Meier approach, a theoretical but useful construct for which we found no evidence of bias compared with using incident cohorts. We recommend this method be used complementary to the competing risks approach, under which MWT is often inestimable, to fill the present information void concerning the seemingly simple question of how long it takes to get a kidney transplant in the United States
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