Many high-priority patients for kidney transplants not on the transplant waiting list


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A new analysis reveals that individuals with kidney failure who are more likely to benefit from kidney transplants are not quickly placed on the transplant waiting list in the United States. The analysis, which appears in an upcoming issue of JASN, also discovered significant racial and socioeconomic disparities in these waiting lists.

Kidney transplantation is the best treatment option for most people with , but receiving a transplant involves many steps, including referring to a transplant center, undergoing evaluations for the transplant, and placing yourself on the transplant waiting list. Changes made several years ago to The allocation system included the use of the Estimated Post Transplant Survival (EPTS) score, designed to identify candidates with the longest predicted post-transplant survival and preferentially assign kidneys of the highest quality to these. . As a result, younger candidates without others who have not had a previous transplant and with little or no dialysis time have lower scores. Candidates who score 20% or less (the “20% higher” EPTS status) have preferential access to quality dead donor kidneys before other candidates. It is important to note that a person’s EPTS score changes over time, so patients will lose their 20% status in the future.

To examine the extent to which patients with 20% higher EPTS status are being placed on the transplant waiting list, Jesse Schold, Ph.D. (Cleveland Clinic) and colleagues examined data from the U.S. Renal Data System for all U.S. adults who had been listed before initiating dialysis (called a preventive list) or who began dialysis. dialysis between 2015 and 2017.

The researchers identified 42,445 patients with 20% EPTS status: 7,922 were classified preventively while 34,523 initiated dialysis. The team found that less than half of eligible patients with a 20% higher EPTS score were placed in the waiting list. Specifically, only 37% of patients who initiated dialysis with an EPTS status greater than 20% had a waiting list within 3 years. African Americans, people without commercial health insurance, and low-income neighborhood residents were less likely to be included on the waiting list.

In addition, 61% of patients who initiated dialysis lost their 20% EPTS status after 30 months, compared with 18% of patients listed preventively. Transplant rates of dead and living donors within 3 years were 5% and 6%, respectively, for patients initiating dialysis, compared with 26% and 44% for classified patients. preventively.

“The results indicate that there are numerous patients with kidney failure who could get 20% higher status but are not on the waiting list. This is important given the high probability that these patients will benefit from the transplant. and lose the first 20% “In the future,” Dr. Schold, “as such, rapid insertion on the waiting list for these patients is very important.”

Dr. Schold also stressed the importance of addressing the racial and socioeconomic disparities revealed by this study. “These findings are important to emphasize the need to develop more effective education, interventions, and policies to streamline access to transplant patients who benefit from it and to mitigate long-standing disparities in these care processes,” he said.

Lower rates of kidney transplant referrals at nonprofit dialysis facilities

More information:
“Patients with high priority for kidney transplantation who are not quickly placed on the transplant waiting list represent missed opportunities.” JASN, DOI: 10.1681 / ASN.2020081146

Citation: Many patients with high priority for kidney transplants not included in the waiting list for transplants (2021, June 17), recovered on June 17, 2021 at 06-patients-high-priority-kidney-transplants.html

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