Jesse D. Schold|Ashwini R. Sehgal|Titte R. Srinivas|E. Poggio|Sankar D. Navaneethan|Bruce Kaplan
Marked Variation of the Association of ESRD Duration Before and After Wait Listing on Kidney Transplant Outcomes
Cleveland Clinic|MetroHealth Medical Center|Case Western Reserve University|Western University of Health Sciences|MetroHealth|Cleveland Clinic|Cleveland Clinic|Cleveland Clinic|University of Arizona
numerous studies report strong association pretransplant endstage renal disease esrd duration diminished transplant outcomes however cumulative waiting time may reflect distinct phases processes related patients physiological condition well preexisting morbidity access care relative impact pre postlisting esrd durations transplant outcomes unknown examined impact intervals national cohort kidney transplant recipients 1999 2008 n 112249 primary factors explaining prelisting esrd duration insurance race primary factors explaining postlisting esrd duration blood type pra variation centers extended time esrd waitlisting significant doseresponse association overall graft loss ahr 126 deceased donors dd ahr 132 living donors ld p values 0001 contrarily time waitlisting esrd transplantation negligible effects p 010dd p 057ld significant associations pre postlisting esrd time posttransplant patient survival however prelisting time sixfold greater effect prelisting esrd time predominately explains association waiting time transplant outcomes suggesting factors associated interval prioritized interventions allocation policy degree effect prelisting esrd time proxy comorbid conditions socioeconomic status access care requires study