Abstract: TH-PO776
Model-Based Inference of the Living-to-Deceased-Donor Ratio among Living Kidney Transplant Patients in the United States
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Joerg, David J., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Fuertinger, Doris H., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Hippen, Benjamin E., Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background
In the United States, statistics on the proportions of incident kidney-transplant patients with living-donor (LD) or deceased-donor (DD) kidneys are available via the Organ Procurement & Transplantation Network (OPTN) database. However, data on the prevalent patient population with an LD/DD kidney transplant is not widely available, as longer-term follow-up and outcomes reporting is not uniform. As DD kidney transplants are more common than LD transplants but also result in inferior mean long-term patient and graft survival, the prevalent population of patients with a functioning transplant by donor-type is likely different from the incident transplant population.
Methods
Using a two-compartment modeling approach capturing transplantation, graft failure and mortality by donor-type, we inferred a range for the LD proportion in 2020. Rates for modelled processes were sourced from the US Renal Data System’s Annual Data Report 2023. A multitude of model simulations (N = 100,000) were performed, initialized with LD proportions ranging between 0% and 100% in 2001, reflecting the uncertainty about past prevalent proportions (Fig. 1a,b). The model then simulated kidney-transplant patient numbers by donor type until 2020.
Results
Model simulations converged towards an LD proportion of 44% ± 3% (mean ± sd.) in 2020 (Fig. 1c), a relatively narrow band compared to the wide range of initial proportions. This is because of mean patient and graft survival times being shorter than the simulation period (19 y). Thus, final proportions are dominated by the balance of incidence, graft failure and mortality in the preceding years.
Conclusion
Modeling results suggest that the proportion of prevalent patients in the U.S. with a functioning graft from a living donor is 45%. Based on these results, the long-term care workforce might be faced with both (a) “long-graft-survivor” living donor recipients disproportionately represented in the prevalent transplant population, and (b) a higher volume of patients with earlier graft failure after deceased donor transplants.
Funding
- Commercial Support – Fresenius Medical Care