Dataset Information

Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.

ABSTRACT:

Rationale & objective

The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys being discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing early allograft failure after transplantation.

Study design

Decision analysis informed by clinical registry data.

Setting & population

We used Organ Procurement and Transplantation Network data to identify 76,044 deceased-donor kidneys procured in the United States from 2013 to 2017, 80% of which were transplanted and 20% discarded.

Intervention

Extend waiting time reinstatement for recipients experiencing allograft failure from the current 90 days to 1 year after transplantation.

Outcome

Net impact to the waitlist, defined as the estimated number of additional transplants minus estimated increase in waiting list reinstatements.

Model, perspective, & timeframe

We estimated (1) the number of additional deceased donor kidneys that would be transplanted if there was a 5%-25% relative reduction in discards, and (2) the number of recipients who would regain waiting time under a 6-, 12-, 18-, and 24-month reinstatement policy.

Results

Reinstating a waiting time for recipients experiencing allograft failure up to 1 year after transplantation yielded more additional transplants than growth in additions to the waiting list for all model assumptions except the combination of a very low relative reduction in discards (5%) and a very high failure rate of transplanted kidneys that would previously have been discarded (≥5 times the rate of currently transplanted kidneys).

Limitations

Lack of empirical evidence supporting the proposed impact of such a policy change.

Conclusions

A policy change reinstating waiting time for deceased donor kidneys recipients with allograft failure up to 1 year after transplantation should explored as a decision science-based intervention to improve organ utilization.

SUBMITTER: Husain SA

PROVIDER: S-EPMC8881308 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.

Husain S Ali SA King Kristen L KL Adler Joel T JT Mohan Sumit S Perotte Rimma R

American journal of kidney diseases : the official journal of the National Kidney Foundation 20210922 3

<h4>Rationale & objective</h4>The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys being discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing early allograft failure after transplantation.<h4>Study design</h4>Decision analysis informed by clinical ...[more]

PMID: 34562524

Similar Datasets

Project description:BackgroundLong waiting times result in low satisfaction. Although several methods are used to shorten the actual waiting time (AWT) in large hospitals of China, the outpatients still have a long actual waiting time. This study aimed to explore whether satisfaction could be improved by extending the expected waiting time (EWT) instead of shortening the AWT.MethodsIn October 2016, 257 students in grade one voluntarily participated in this study. They came from 6 classes, which were randomly divided into two groups: 3 classes comprised the control group (n = 125) and 3 classes comprised the experimental group (n = 132). Unfavorable information (UI) was given to the experimental group alone. Six distinct questionnaires were designed to explore the effects of UI on EWT and the effects of an extended EWT on satisfaction. Satisfaction scores ranged from 0 to 100: 0-25, very dissatisfied; 26-50, dissatisfied; 51-75, satisfied; 76-100, very satisfied. Each participant finished one of the 6 questionnaires online. Of the 257 questionnaires, 233 were valid.ResultsBefore UI was given, the initial EWT (T0) was similar between the control and experimental groups (Z = -1.924, P = 0.054). Under the effects of UI, individuals in the experimental group extended their EWT (T1) from 121.0 to 180.0 min (Z = -6.367, P < 0.001). Females prolonged their EWT longer than males did (Z = -2.239, P = 0.025). Then, this study defined T0 = 1.5 h and T1 = 2.5 h, and compared the satisfaction scores between the control and experimental groups: a significant difference was found when AWT =2.0 h (t = - 3.568, P = 0.001), but not when AWT =3.0 h (t = - 0.718, P = 0.475) or when AWT =1.0 h (t = - 1.088, P = 0.280). When AWT =3.0 h, fewer individuals felt "very dissatisfied" in the experimental group (21.2%) than in the control group (44.7%) (χ2 = 4.368, P = 0.037).ConclusionsEWT was found to be extended greatly by UI. An extended EWT could improve satisfaction scores.

Project description:Background & aimsFrailty is prevalent in liver transplant (LT) candidates. It is considered an independent predictor of adverse outcomes pre- and post-transplant according to data obtained in the United States. We aimed to externally validate the liver frailty index (LFI) in a multicenter cohort of LT candidates.MethodsOutpatients with cirrhosis were prospectively recruited from five Spanish centers (2018-2020). Patients were defined as "frail" by an optimal cut-off of LFI ≥4.5. Patients were followed for at least 6 months to study associations of pre-LT frailty with pre- and post-transplant mortality, length of hospital and intensive care unit (ICU) stays, risk of early (<30 days) and late (30-90 days) post-transplant complications, retransplantation and cardiovascular events.ResultsOf 212 patients included, 45 patients (21%) were frail pre-LT, and the median LFI was 3.9 (IQR 3.5-4.4). After a median waiting time of 78 days, 2% died or were delisted for clinical worsening. The LFI at baseline was not predictive of mortality/delisting in LT candidates in univariable or multivariable analyses after adjusting for age and MELD-Na score (hazard ratio 1.48; p = 0.586). In contrast, compared to non-frail patients, frail LT candidates had a significantly higher length of hospital stay (9 vs. 13 days; p = 0.001) and rate of early (<30 days) post-transplant complications (55% vs. 100%; p = 0.021).ConclusionsIn the context of a short LT waiting time, frailty does not impact pretransplant mortality and/or delisting. In contrast, LT frailty is predictive of higher post-transplant complication rates and length of hospital stay. Whether strategies aimed at pre- and/or re-habilitation are beneficial in settings with short waiting times needs to be confirmed in prospective studies.Impact and implicationsLiterature is scarce on the actual impact of physical frailty on adverse outcomes in the liver transplant scenario outside North America. Evidence-based justification to extend the use of objective frailty tools in the decision-making processes in other liver transplant settings is needed. This study is the first to evaluate the predictive value of the liver frailty index in outpatients in the European liver transplant setting, showing that in a low MELD, high access system, frailty does not impact pretransplant mortality and/or delisting but is predictive of higher complication rates and longer post-transplant length of stay. In practical ways, physicians should consider physical frailty as a vital sign to be measured systematically and routinely during clinic visits; researchers are encouraged to initiate prospective studies to evaluate the benefit of applying strategies aimed at pre- and or re-habilitation in liver transplant settings with short waiting times.

Project description:BackgroundA time factor of radiooncological treatment has been demonstrated for several tumours, most prominently for head and neck squamous cell carcinoma and lung cancer. In glioblastoma multiforme studies of the impact of postoperative waiting times before initiation of radio- or radiochemotherapy were inconclusive. Moreover analysis of the impact of overall treatment time of radiochemotherapy as well as overall duration of local treatment from surgery to the end of radiochemotherapy is lacking to date.MethodsIn this retrospective cohort study, we included 369 consecutive patients treated at our institution between 2001 and 2014. Inclusion criteria were histologically proven glioblastoma multiforme, age ≥ 18 years, ECOG performance status 0-2 before radiotherapy, radiotherapy or radiochemotherapy with 33 × 1.8 Gy to 59.4 Gy or with 30 × 2.0 Gy to 60 Gy. The impact of postoperative waiting time, radiation treatment time and overall duration of local treatment from surgery to the end of radiotherapy on overall (OS) and progression-free (PFS) survival were evaluated under consideration of known prognostic factors by univariate Log-rank tests and multivariate Cox-regression analysis.ResultsThe majority of patients had received simultaneous and further adjuvant chemotherapy, mainly with temozolomide. Median survival time and 2-year OS were 18.0 months and 38.9% after radiochemotherapy compared to 12.7 months and 12.6% after radiotherapy alone. Median progression-free survival time was 7.5 months and PFS at 2 years was 14.3% compared to 6.0 months and 3.3%, respectively. Significant prognostic factors in multivariate analysis were age, resection status and application of simultaneous chemotherapy. No effect of the interval between surgery and adjuvant radiotherapy (median 27, range 11-112 days), radiation treatment time (median 45, range 40-71 days) and of overall time from surgery until the end of radiotherapy (median 54, range 71-154 days) on overall and progression-free survival was evident.ConclusionOur data do not indicate a relevant time factor in the treatment of glioblastoma multiforme in a large contemporary single-centre cohort. Although this study was limited by its retrospective nature, its results indicate that short delays of postoperative radiochemotherapy, e.g. for screening of a patient for a clinical trial, may be uncritical.

Project description:Value added services (VAS) are an innovative dispensing system created to provide an alternative means of collecting partial drug supply from our hospital. This in turn was projected to reduce the necessity for patient to visit pharmacy counter and thus reduce the burden of prescription handling.To evaluate the impact of increased VAS uptake following promotional campaign towards patient waiting time and to explore factors that may affect patient waiting time at the Ambulatory Pharmacy, Queen Elizabeth Hospital.A quasi experimental study design was conducted from September 2014 till June 2015 at the Ambulatory Pharmacy. During pre-intervention phase, baseline parameters were collected retrospectively. Then, VAS promotional campaign was carried out for six months and whilst this was done, the primary outcome of patient waiting time was measured by percentage of prescription served less than 30 minutes. A linear regression analysis was used to determine the impact of increased VAS uptake towards patient waiting time.An increased in percentage of VAS registration (20.9% vs 35.7%, p<0.001) was observed after the promotional campaign. The mean percentage of prescription served less than 30 minutes increased from 83.2% SD=15.9 to 90.3% SD=11.5, p=0.001. After controlling for covariates, it was found that patient waiting time was affected by number of pharmacy technicians (b=-0.0349, 95%CI-0.0548 : -0.0150, p=0.001), number of pharmacy counters (b=0.1125, 95%CI 0.0631 : 0.1620, p<0.001), number of prescriptions (b=0.0008, 95%CI 0.0004 : 0.0011, p<0.001), and number of refill prescriptions (b=0.0004, 95%CI 0.0002 : 0.0007, p<0.001). The increased in percentage of VAS registration was associated with reduction in number of refill prescription (b=-2.9838, 95%CI -4.2289 : -1.7388, p<0.001).Patient waiting time at the Ambulatory Pharmacy improved with the increased in VAS registration. The impact of increased VAS uptake on patient waiting time resulted from reduction in refill prescriptions. Patient waiting time is influenced by number of pharmacy technicians, number of pharmacy counters, number of prescriptions and number of refill prescriptions.

Dataset Information

Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.

Rationale & objective

Study design

Setting & population

Intervention

Outcome

Model, perspective, & timeframe

Results

Limitations

Conclusions

Publications

Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets