Kidney transplant candidacy evaluation and waitlisting practices in the United States and their association with access to transplantation
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons..
There are limited data on the degree of variability in practices surrounding prioritization of referrals for transplant evaluation and criteria for transplant candidacy and their association with transplantation rates. We surveyed transplant programs across the United States between January 2020 and May 2020 to determine current pre-transplantation practices. We examined the relation between these reported practices and the outcomes of waitlisted patients at responding programs between January 2015 and March 2021 using Scientific Registry of Transplant Recipients data. We used adjusted Cox models with random effects to accommodate clustering by program. Primary outcomes included living or deceased donor transplantation. Of 172 surveyed programs, 90 participated. Substantial variations were noted in when the candidacy evaluation began (13% reported when eGFR was <30 mL/min/1.73 m2 and 17% reported no set policy) and the approach to pre-transplantation cardiac workup (multi-modality [58%], stress echocardiogram [20%]). Using adjusted models, a program policy of using other measures of body habitus to determine transplant candidacy rather than requiring patients to meet a body mass index (BMI) threshold of ≤35 kg/m2 (reference group) for candidacy was associated with a higher hazard of living donor transplantation (HR 1.83 [95% CI 1.10-3.03]). Pre-transplant practices vary substantially across the United States, and select practices were associated with transplantation rates.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - 22(2022), 6 vom: 23. Juni, Seite 1624-1636 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Whelan, Adrian M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.06.2022 Date Revised 02.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/ajt.17031 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM338197990 |
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| 245 | 1 | 0 | |a Kidney transplant candidacy evaluation and waitlisting practices in the United States and their association with access to transplantation |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The American Society of Transplantation and the American Society of Transplant Surgeons. | ||
| 520 | |a There are limited data on the degree of variability in practices surrounding prioritization of referrals for transplant evaluation and criteria for transplant candidacy and their association with transplantation rates. We surveyed transplant programs across the United States between January 2020 and May 2020 to determine current pre-transplantation practices. We examined the relation between these reported practices and the outcomes of waitlisted patients at responding programs between January 2015 and March 2021 using Scientific Registry of Transplant Recipients data. We used adjusted Cox models with random effects to accommodate clustering by program. Primary outcomes included living or deceased donor transplantation. Of 172 surveyed programs, 90 participated. Substantial variations were noted in when the candidacy evaluation began (13% reported when eGFR was <30 mL/min/1.73 m2 and 17% reported no set policy) and the approach to pre-transplantation cardiac workup (multi-modality [58%], stress echocardiogram [20%]). Using adjusted models, a program policy of using other measures of body habitus to determine transplant candidacy rather than requiring patients to meet a body mass index (BMI) threshold of ≤35 kg/m2 (reference group) for candidacy was associated with a higher hazard of living donor transplantation (HR 1.83 [95% CI 1.10-3.03]). Pre-transplant practices vary substantially across the United States, and select practices were associated with transplantation rates | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Scientific Registry for Transplant Recipients (SRTR) | |
| 650 | 4 | |a clinical research/practice | |
| 650 | 4 | |a kidney transplantation/nephrology | |
| 650 | 4 | |a recipient selection | |
| 650 | 4 | |a registry/registry analysis | |
| 650 | 4 | |a survey | |
| 700 | 1 | |a Johansen, Kirsten L |e verfasserin |4 aut | |
| 700 | 1 | |a Copeland, Timothy |e verfasserin |4 aut | |
| 700 | 1 | |a McCulloch, Charles E |e verfasserin |4 aut | |
| 700 | 1 | |a Nallapothula, Dhiraj |e verfasserin |4 aut | |
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| 700 | 1 | |a Roll, Garrett R |e verfasserin |4 aut | |
| 700 | 1 | |a Weir, Matthew R |e verfasserin |4 aut | |
| 700 | 1 | |a Adey, Deborah B |e verfasserin |4 aut | |
| 700 | 1 | |a Ku, Elaine |e verfasserin |4 aut | |
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