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Kidney Week

Abstract: FR-PO1179

Noncompliance: A Significant Contributor for Renal Allograft Loss

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kalra, Kartik, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Tandukar, Srijan, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Jorgensen, Dana R., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Mehta, Rajil B., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Sood, Puneet, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Wu, Christine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Puttarajappa, Chethan M., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Shah, Nirav A., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Hariharan, Sundaram, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Background

United network for organ sharing (UNOS) implemented the new kidney allocation system (KAS) in 2014 to reduce inequity and improve life-years gained from kidney transplantation (KT). KAS allowed matching of high quality kidneys to younger recipients and allowed backdating of waitlist date to account for dialysis vintage. Additionally, transplant centers have aimed to increase access to KT by streamlining evaluation process and reducing barriers to wait listing. Potential unintended consequences of these policies may be selection of patients with higher disease burden and lower social support. We investigated this by examining causes of allograft loss within the first 5 years at our center.

Methods

Single center study of kidney transplant recipients between 2013- 2017. Causes of death-censored allograft loss was examined using the following 7 categories: 1. Non Compliance (medication, follow up, blood work), 2. Donor Related (High KDPI), 3. Rejection (Acute/Chronic T- Cell and Antibody Mediated Rejection), 4. Recurrence of primary kidney disease, 5. Surgical/Technical, 6. Infection Related (BK Virus, Pyelonephritis), 7. Others. Differences in baseline characteristics for patients with and without noncompliance were examined.

Results


18 of 63 (29%) graft losses were attributed to noncompliance. Noncompliance group had younger patients (mean age 38 y vs 55 y; p=0.0001) and higher proportion of African American race (47% vs 22%;p=0.055)

Conclusion


Early allograft loss due to noncompliance is high and is more common among African Americans and young patients. This might offset the potential benefits arising from the new KAS. This data should be used to further investigate specific reasons for non-adherence that can be targeted for intervention.

Demographics and Results