Journal articles: 'Access to waiting list and kidney transplant'

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Adoli, Latame, Maxime Raffray, Valérie Châtelet, Cécile Vigneau, Thierry Lobbedez, Fei Gao, Florian Bayer, et al. "Women’s Access to Kidney Transplantation in France: A Mixed Methods Research Protocol." International Journal of Environmental Research and Public Health 19, no. 20 (October 19, 2022): 13524. http://dx.doi.org/10.3390/ijerph192013524.

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Kidney transplantation is the best renal replacement therapy (medically and economically) for eligible patients with end-stage kidney disease. Studies in some French regions and in other countries suggest a lower access to the kidney transplant waiting listing and also to kidney transplantation, once waitlisted, for women. Using a mixed methods approach, this study aims to precisely understand these potential sex disparities and their causes. The quantitative study will explore the geographic disparities, compare the determinants of access to the waiting list and to kidney transplantation, and compare the reasons and duration of inactive status on the waiting list in women and men at different scales (national, regional, departmental, and census-block). The qualitative study will allow describing and comparing women’s and men’s views about their disease and transplantation, as well as nephrologists’ practices relative to the French national guidelines on waiting list registration. This type of study is important in the current societal context in which the reduction of sex/gender-based inequalities is a major social expectation.

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Pussell, B. A., A. Bendorf, and I. H. Kerridge. "Access to the kidney transplant waiting list: a time for reflection." Internal Medicine Journal 42, no. 4 (April 2012): 360–63. http://dx.doi.org/10.1111/j.1445-5994.2012.02730.x.

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Barth, Anita, Gergő József Szőllősi, and Balázs Nemes. "Factors Affecting Access to the Kidney Transplant Waiting List in Eastern Hungary." Transplantation Proceedings 53, no. 5 (June 2021): 1418–22. http://dx.doi.org/10.1016/j.transproceed.2021.01.044.

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King, Kristen L., S. Ali Husain, Jesse D. Schold, Rachel E. Patzer, Peter P. Reese, Zhezhen Jin, Lloyd E. Ratner, David J. Cohen, Stephen O. Pastan, and Sumit Mohan. "Major Variation across Local Transplant Centers in Probability of Kidney Transplant for Wait-Listed Patients." Journal of the American Society of Nephrology 31, no. 12 (October 9, 2020): 2900–2911. http://dx.doi.org/10.1681/asn.2020030335.

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BackgroundGeographic disparities in access to deceased donor kidney transplantation persist in the United States under the Kidney Allocation System (KAS) introduced in 2014, and the effect of transplant center practices on the probability of transplantation for wait-listed patients remains unclear.MethodsTo compare probability of transplantation across centers nationally and within donation service areas (DSAs), we conducted a registry study that included all United States incident adult kidney transplant candidates wait listed in 2011 and 2015 (pre-KAS and post-KAS cohorts comprising 32,745 and 34,728 individuals, respectively). For each center, we calculated the probability of deceased donor kidney transplantation within 3 years of wait listing using competing risk regression, with living donor transplantation, death, and waiting list removal as competing events. We examined associations between center-level and DSA-level characteristics and the adjusted probability of transplant.ResultsCandidates received deceased donor kidney transplants within 3 years of wait listing more frequently post-KAS (22%) than pre-KAS (19%). Nationally, the probability of transplant varied 16-fold between centers, ranging from 4.0% to 64.2% in the post-KAS era. Within DSAs, we observed a median 2.3-fold variation between centers, with up to ten-fold and 57.4 percentage point differences. Probability of transplantation was correlated in the post-KAS cohort with center willingness to accept hard-to-place kidneys (r=0.55, P<0.001) and local organ supply (r=0.44, P<0.001).ConclusionsLarge differences in the adjusted probability of deceased donor kidney transplantation persist under KAS, even between centers working with the same local organ supply. Probability of transplantation is significantly associated with organ offer acceptance patterns at transplant centers, underscoring the need for greater understanding of how centers make decisions about organs offered to wait-listed patients and how they relate to disparities in access to transplantation.

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Dall’Agnol, Juliana, Eda Schwartz, and Fernanda Lise. "Acesso à lista de espera para o transplante renal." Revista Recien - Revista Científica de Enfermagem 11, no. 35 (September 23, 2021): 174–84. http://dx.doi.org/10.24276/rrecien2021.11.35.174-184.

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Descrever os fatores que dificultam o acesso dos indivíduos em terapia de substituição renal à lista de espera para o transplante renal à nível mundial por meio da revisão bibliográfica sistemática. Atende as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A qualidade metodológica dos artigos foi avaliada de acordo com o Strengthening the Reporting of Observational Studies in Epidemiology. A estratégia PICO foi utilizada para busca das evidências que foram analisadas de forma descritiva e apresentadas em categorias temáticas. Os dez artigos apontam fatores demográficos, clínicos, socioeconômicos, geográficos, motivos referidos e de características do serviço como fatores que dificultam o acesso à lista de espera para o transplante renal. A decisão do indivíduo e sua família deve ser respeitada, entretanto, os serviços de terapia de substituição renal necessitam promover a qualificação dos profissionais e investir na estrutura destes serviços.Descritores: Transplante de Rim, Enfermagem, Listas de Espera, Acesso à Informação. Access to the kidney transplant waiting listAbstract: To describe the factors that make it difficult for individuals on renal replacement therapy to access the kidney transplantation waiting list worldwide through a systematic literature review. It attends the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. The methodological quality of the articles was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology. The PICO strategy was used and the evidence was analyzed descriptively and presented in thematic categories. The ten papers point to demographic, clinical, socioeconomic, geographic factors, reasons mentioned and service characteristics as factors that hinder access to the waiting list for kidney transplantation. The decision of the individual and the family must be respected, however, renal replacement therapy services need to promote the qualification of professionals and invest in the structure of these services.Descriptors: Kidney Transplantation, Nursing, Waiting Lists, Access to Information. Acceso a la lista de espera de trasplante de riñónResumen: Describir los factores que dificultan el acceso de los individuos en tratamiento sustitutivo renal a la lista de espera para trasplante renal en todo el mundo mediante una revisión sistemática de la literatura. Cumple con los elementos Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. La calidad metodológica de los artículos se evaluó de acuerdo con Strengthening the Reporting of Observational Studies in Epidemiology. Se utilizó la estrategia PICO para la búsqueda de evidencias que se analizaron descriptivamente y se presentaron en categorías temáticas. Los diez artículos apuntan a factores demográficos, clínicos, socioeconómicos, geográficos, razones mencionadas y características del servicio como factores que dificultan el acceso a la lista de espera para trasplante renal. Se debe respetar la decisión del individuo y su familia, sin embargo, los servicios de terapia sustitutiva renal deben promover la calificación de los profesionales e invertir en la estructura de estos servicios.Descriptores: Transplante de Riñon, Enfermería, Listas de Espera, Acceso a la Información.

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Kasiske, B. L., W. London, and M. D. Ellison. "Race and socioeconomic factors influencing early placement on the kidney transplant waiting list." Journal of the American Society of Nephrology 9, no. 11 (November 1998): 2142–47. http://dx.doi.org/10.1681/asn.v9112142.

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This cohort study investigates whether there are inequities in the current system for listing patients for cadaveric renal transplantation, using univariate and multivariate analyses to identify factors associated with early registration before initiation of dialysis. It includes patient registrations for the kidney and kidney-pancreas waiting lists between April 1, 1994, and June 30, 1996 (n = 41,596) from all 238 United Network for Organ Sharing renal transplant centers. Patient and center factors predicting dialysis status (pre- or postdialysis initiation) at the time of registration were examined. Independent predictors of listing before dialysis (P < 0.001) included: female (odds ratio [OR] = 1.14, reference: male, i.e., listing before dialysis was 14% more likely in females than in males); age < or =17 and age 18 to 55 (OR = 1.91 and 1.14, respectively, reference: age >55); prior transplant (OR = 1.80, reference: no prior transplant); 0 to 8 yr education, attended college, and received a college degree (OR = 0.78, 1.18, and 1.37, respectively, reference: high school degree); black race, Hispanic, and Asian/other (OR = 0.47, 0.59, and 0.55, reference: white); full-time employment (OR = 1.98, reference: less than full time); payment with Medicare and private insurance (OR = 0.35 and 1.24, respectively, reference: other pay); receiving insulin (OR = 1.29, reference; not on insulin); listed for kidney-pancreas (OR = 1.43, reference: listed for kidney only); listed at a center with volume >400 (OR = 1.22, reference: volume <400). To remove possible bias for general access to health care and referral for transplantation, the analysis was limited to patients who had a previous transplant and found similar results. It is concluded that racial and ethnic minorities, those less well educated, and those with fewer financial resources are less likely than their counterparts to be listed for renal transplantation before dialysis. These results suggest there may be remediable inequities in the current system for registration for renal transplantation in the United States. Education efforts directed at patients and providers, as well as recently mandated uniform listing criteria for cadaveric organ transplantation, may help to reduce these inequities.

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Talamantes, Efrain, Keith C. Norris, Carol M. Mangione, Gerardo Moreno, Amy D. Waterman, John D. Peipert, Suphamai Bunnapradist, and Edmund Huang. "Linguistic Isolation and Access to the Active Kidney Transplant Waiting List in the United States." Clinical Journal of the American Society of Nephrology 12, no. 3 (February 9, 2017): 483–92. http://dx.doi.org/10.2215/cjn.07150716.

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Dziodzio, Tomasz, Karl Herbert Hillebrandt, Sebastian Knitter, Maximilian Nösser, Brigitta Globke, Paul Viktor Ritschl, Matthias Biebl, et al. "Body Mass Index Thresholds and the Use of Bariatric Surgery in the Field of Kidney Transplantation in Germany." Obesity Surgery 32, no. 5 (March 19, 2022): 1641–48. http://dx.doi.org/10.1007/s11695-022-06000-4.

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Abstract Background Obesity in the recipient is linked to inferior transplant outcome. Consequently, access to kidney transplantation (KT) is often restricted by body mass index (BMI) thresholds. Bariatric surgery (BS) has been established as a superior treatment for obesity compared to conservative measures, but it is unclear whether it is beneficial for patients on the waiting list. Methods A national survey consisting of 16 questions was sent to all heads of German KT centers. Current situation of KT candidates with obesity and the status of BS were queried. Results Center response rate was 100%. Obesity in KT candidates was considered an important issue (96.1%; n = 49/51) and 68.6% (n = 35/51) of departments responded to use absolute BMI thresholds for KT waiting list access with ≥ 35 kg/m2 (45.1%; n = 23/51) as the most common threshold. BS was considered an appropriate weight loss therapy (92.2%; n = 47/51), in particular before KT (88.2%; n = 45/51). Sleeve gastrectomy was the most favored procedure (77.1%; n = 37/51). Twenty-one (41.2%) departments responded to evaluate KT candidates with obesity by default but only 11 (21.6%) had experience with ≥ n = 5 transplants after BS. Concerns against BS were malabsorption of immunosuppressive therapy (39.2%; n = 20/51), perioperative morbidity (17.6%; n = 9/51), and malnutrition (13.7%; n = 7/51). Conclusions Obesity is potentially limiting access for KT. Despite commonly used BMI limits, only few German centers consider BS for obesity treatment in KT candidates by default. A national multicenter study is desired by nearly all heads of German transplant centers to prospectively assess the potentials, risks, and safety of BS in KT waitlisted patients. Graphical abstract

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Schold, Jesse D., Sumit Mohan, Anne Huml, Laura D. Buccini, John R. Sedor, Joshua J. Augustine, and Emilio D. Poggio. "Failure to Advance Access to Kidney Transplantation over Two Decades in the United States." Journal of the American Society of Nephrology 32, no. 4 (February 11, 2021): 913–26. http://dx.doi.org/10.1681/asn.2020060888.

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BackgroundExtensive research and policies have been developed to improve access to kidney transplantation among patients with ESKD. Despite this, wide variation in transplant referral rates exists between dialysis facilities.MethodsTo evaluate the longitudinal pattern of access to kidney transplantation over the past two decades, we conducted a retrospective cohort study of adult patients with ESKD initiating ESKD or placed on a transplant waiting list from 1997 to 2016 in the United States Renal Data System. We used cumulative incidence models accounting for competing risks and multivariable Cox models to evaluate time to waiting list placement or transplantation (WLT) from ESKD onset.ResultsAmong the study population of 1,309,998 adult patients, cumulative 4-year WLT was 29.7%, which was unchanged over five eras. Preemptive WLT (prior to dialysis) increased by era (5.2% in 1997–2000 to 9.8% in 2013–2016), as did 4-year WLT incidence among patients aged 60–70 (13.4% in 1997–2000 to 19.8% in 2013–2016). Four-year WLT incidence diminished among patients aged 18–39 (55.8%–48.8%). Incidence of WLT was substantially lower among patients in lower-income communities, with no improvement over time. Likelihood of WLT after dialysis significantly declined over time (adjusted hazard ratio, 0.80; 95% confidence interval, 0.79 to 0.82) in 2013–2016 relative to 1997–2000.ConclusionsDespite wide recognition, policy reforms, and extensive research, rates of WLT following ESKD onset did not seem to improve in more than two decades and were consistently reduced among vulnerable populations. Improving access to transplantation may require more substantial interventions.

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Furth, Susan L., Pushkal Garg, Alicia M. Neu, Wenke Hwang, Barbara A. Fivush, and Neil R. Powe. "Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents with ESRD." Pediatric Research 45, no. 4, Part 2 of 2 (April 1999): 332A. http://dx.doi.org/10.1203/00006450-199904020-01974.

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Furth, S. L., P. Garg, A. M. Neu, W. Hwang, B. A. Fivush, and N. R. Powe. "RACIAL DIFFERENCES IN ACCESS TO THE KIDNEY TRANSPLANT WAITING LIST FOR CHILDREN AND ADOLESCENTS WITH ESRD." Transplantation 67, no. 7 (April 1999): S237. http://dx.doi.org/10.1097/00007890-199904150-00947.

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Caldara, Rossana. "Rene Policistico e trapianto di rene: accesso alla lista d’attesa e post trapianto: risultati della ricerca." Giornale di Tecniche Nefrologiche e Dialitiche 31, no. 3 (September 2019): 176–82. http://dx.doi.org/10.1177/0394936219876868.

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Polycystic kidney disease and kidney transplantation: access to waiting list and post-transplant Autosomal-dominant polycystic kidney disease (ADPKD) is the leading genetic cause of end-stage renal disease (ESRD) worldwide. The number of ADPKD patients who are listed for transplantation or receive a kidney transplant is continuously increasing over time. AIRP conducted a survey to investigate the ADPKD patient journey, meaning the personal experience and expectations of people regarding kidney transplantation as therapeutic option of end-stage renal failure. The survey was conducted on 381 people with ADPKD, using computer-assisted web interviewing (CAWI). The results confirm that there are problems that need to be addressed before listing an ADPKD patient for a kidney transplantation, namely the patient’s comorbidities, the complexity of pre-transplant assessments and the shortage of organs. Pre-emptive transplantation from cadaver donor is a rare event in our country but it is a valid option, especially in case of living donation. Immunosuppression is well tolerated in a high percentage of subjects, but a follow-up is necessary to monitor negative side effects. Despite these problems, the outcome of kidney transplantation is optimal in these patients. Also, the relationship between patients and Nephrologists and/or Transplant Centers is important to ensure a positive outcome.

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Udayaraj, Udaya, Yoav Ben-Shlomo, Paul Roderick, Anna Casula, Chris Dudley, Rachel Johnson, Dave Collett, David Ansell, Charles Tomson, and Fergus Caskey. "Social Deprivation, Ethnicity, and Access to the Deceased Donor Kidney Transplant Waiting List in England and Wales." Transplantation 90, no. 3 (August 2010): 279–85. http://dx.doi.org/10.1097/tp.0b013e3181e346e3.

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Keith, D., and J. Ma. "A Longitudinal Analysis of Disparities in Access to the Kidney Transplant Waiting List in the United States." Transplantation 98 (July 2014): 831. http://dx.doi.org/10.1097/00007890-201407151-02836.

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Randhawa, Gurch. "Promoting Organ Donation and Transplantation among South Asians in the United Kingdom: The Role of Social Networks in the South Asian Community." Progress in Transplantation 15, no. 3 (September 2005): 286–90. http://dx.doi.org/10.1177/152692480501500314.

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The percentage of South Asians on the kidney transplant waiting list in the United Kingdom is 3 times their percentage in the general population. Obviously, organ donation and transplantation among South Asians in the United Kingdom needs improvement. In recent years, ethnically targeted campaigns in the mass media have specifically attempted to attract donors from the South Asian communities. A number of pilot studies have been done to evaluate the effectiveness of these initiatives in providing information about organ donation to South Asians. Results indicate that detailed information related to transplantation was learned mainly by people within the community receiving transplants and was transmitted through various informal community networks rather than through the resources provided by the Department of Health. This article provides an overview of who South Asians are and how these community networks were established. Transplant professionals must devise effective strategies to access these community networks, thereby raising the consciousness of transplantation among South Asians in the United Kingdom.

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Grèze, Clarisse, Bruno Pereira, Yves Boirie, Laurent Guy, Clémentine Millet, Guillaume Clerfond, Cyril Garrouste, and Anne-Elisabeth Heng. "Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014." Nephrology Dialysis Transplantation 37, no. 3 (October 5, 2021): 584–94. http://dx.doi.org/10.1093/ndt/gfab277.

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ABSTRACT Background The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes. Methods We carried out a prospective cohort study using two French registries, the Renal Epidemiology and Information Network and CRISTAL, on 7270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (obese WL and obese nWL). Results The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients {hazard ratio (HR) = 1.40, [95% confidence interval (95% CI) 1.09; 1.78], P = 0.007}, whereas patient survival was similar [HR = 0.94, (95% CI 0.73; 1.23), P = 0.66]. Graft survival was significantly lower in obese WL than in obese nWL [HR = 2.17, (1.02; 4.63), P = 0.045], whereas patient survival was similar in the two groups [HR = 0.79, (0.35; 1.77), P = 0.56]. Conclusion Grade 1 obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in these patients should not be essential for registration on waiting list.

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Bae, Sunjae, Morgan Johnson, Allan B. Massie, Xun Luo, Carlton Haywood, Sophie M. Lanzkron, Morgan E. Grams, Dorry L. Segev, and Tanjala S. Purnell. "Mortality and Access to Kidney Transplantation in Patients with Sickle Cell Disease–Associated Kidney Failure." Clinical Journal of the American Society of Nephrology 16, no. 3 (February 25, 2021): 407–14. http://dx.doi.org/10.2215/cjn.02720320.

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Background and objectivesPatients with sickle cell disease–associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population, potentially limiting their chance of receiving transplantation. We aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure.Design, setting, participants, & measurementsUsing a national registry, we studied all adults with kidney failure who began maintenance dialysis or were added to the kidney transplant waiting list in 1998–2017. To quantify the decrease in mortality associated with transplantation, we measured the absolute risk difference and hazard ratio for mortality in matched pairs of transplant recipients versus waitlisted candidates in the sickle cell and control groups. To compare the chance of receiving transplantation, we estimated hazard ratios for receiving transplantation in the sickle cell and control groups, treating death as a competing risk.ResultsCompared with their matched waitlisted candidates, 189 transplant recipients with sickle cell disease and 220,251 control recipients showed significantly lower mortality. The absolute risk difference at 10 years post-transplant was 20.3 (98.75% confidence interval, 0.9 to 39.8) and 19.8 (98.75% confidence interval, 19.2 to 20.4) percentage points in the sickle cell and control groups, respectively. The hazard ratio was also similar in the sickle cell (0.57; 95% confidence interval, 0.36 to 0.91) and control (0.54; 95% confidence interval, 0.53 to 0.55) groups (interaction P=0.8). Nonetheless, the sickle cell group was less likely to receive transplantation than the controls (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.61 to 0.87). Similar disparities were found among waitlisted candidates (subdistribution hazard ratio, 0.62; 95% confidence interval, 0.53 to 0.72).ConclusionsPatients with sickle cell disease–associated kidney failure exhibited similar decreases in mortality associated with kidney transplantation as compared with those with other kidney failure etiologies. Nonetheless, the sickle cell population was less likely to receive transplantation, even after waitlist registration.

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Vatazin, V. A., A. B. Zulkarnaev, and V. A. Stepanov. "Clinical, immunological and ethical aspects of selecting a recipient for cadaver kidney transplantation." Russian Journal of Transplantology and Artificial Organs 22, no. 1 (April 23, 2020): 209–19. http://dx.doi.org/10.15825/1995-1191-2020-1-209-219.

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The decision to choose a particular patient for kidney transplantation is made through two consecutive decisions: decision to include the patient on the waiting list and decision to select a patient competitively among several candidates for transplant. Both decisions are taken amidst many competing priorities and require a multidisciplinary approach. This paper provides comparative analysis of the principles of maintaining a waitlist and selecting a donor–recipient pair in Russia, Europe (Eurotransplant) and the USA (UNOS). Donor–recipient pair is selected based on the traditional hierarchical scheme of decision rules. Unlike Eurotransplant and UNOS, there are no uniform standards in Russia for assessing the quality of a donor organ. The widespread and largely vague «old for old» principle should be harmoniously fitted into the general outline of donor kidney distribution. The second difference in the national distribution system of donor kidneys is the choice in favor of a candidate with a lesser degree of sensitization. With high frequency of positive cross-test, this principle, in a synergistic manner, greatly reduces the availability of transplantation for highly sensitized candidates. The quality of donor organ and unconditional priority on highly sensitized candidates are the conceptual fundamental principles of organ distribution in the US and Europe. Under donor kidney shortage, selecting a recipient is always competitive. The choice of a candidate can be based on a patient-oriented approach (a choice in favor of the candidate whose transplantation will most likely reduce the risk of death; for example, an «emergency» waiting list) or an alternative – a utilitarian approach (choosing the candidate with the longest predictable life expectancy). However, radical commitment to one of these approaches inevitably reduces availability of kidney transplantation for a specific category of patients. For a justified choice of recipient, it is necessary to correlate such factors as comorbidity, waiting time, age, histocompatibility and quality of donor kidney. This would achieve a shaky balance between utilitarian approach and patient-oriented approach. The principles of creating a waiting list and a system for efficient distribution of donor organs practiced by foreign organizations cannot be simply copied and reproduced in Russia. It is necessary to adapt and validate such principles for the local patient population. The objective difficulties of such an analysis dictate the need to address it on a national scale. This would ensure equitable distribution of donor organs to all patients in need and obtain the best transplant results. Moreover, this would make it possible to achieve the full potential of donor organs. Conclusions. The situation in transplantological and nephrological care in Russia is gradually changing. This determines the need to adapt and standardize approaches to allocation of cadaveric donor kidneys in order to ensure equal access to transplantation for different patients and fullest realization of their potential. Removing organ distribution from the area of responsibility of local coordination councils, introducing a unified policy for distribution of donor organs and choosing a specific recipient will reduce the subjectivity of decisions and, possibly, improve transplantation results.

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Furth, S. L., P. P. Garg, A. M. Neu, W. Hwang, B. A. Fivush, and N. R. Powe. "Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents With End-Stage Renal Disease." PEDIATRICS 106, no. 4 (October 1, 2000): 756–61. http://dx.doi.org/10.1542/peds.106.4.756.

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Whelan, Adrian M., Kirsten L. Johansen, Sandeep Brar, Charles E. McCulloch, Deborah B. Adey, Garrett R. Roll, Barbara Grimes, and Elaine Ku. "Association between Longer Travel Distance for Transplant Care and Access to Kidney Transplantation and Graft Survival in the United States." Journal of the American Society of Nephrology 32, no. 5 (March 12, 2021): 1151–61. http://dx.doi.org/10.1681/asn.2020081242.

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BackgroundTransplant candidates may gain an advantage by traveling to receive care at a transplant center that may have more favorable characteristics than their local center. Factors associated with longer travel distance for transplant care and whether the excess travel distance (ETD) is associated with access to transplantation or with graft failure are unknown.MethodsThis study of adults in the United States wait-listed for kidney transplantation in 1995–2015 used ETD, defined as distance a patient traveled beyond the nearest transplant center for initial waiting list registration. We used linear regression to examine patient and center characteristics associated with ETD and Fine–Gray models to examine the association between ETD (modeled as a spline) and time to deceased or living donor transplantation or graft failure.ResultsOf 373,365 patients, 11% had an ETD≥50 miles. Traveling excess distance was more likely among patients who were of non-Black race or those whose nearest transplant center had lower annual living donor transplant volume. At an ETD of 50 miles, we observed a lower likelihood of deceased donor transplantation (subhazard ratio [SHR], 0.85; 95% confidence interval [95% CI], 0.84 to 0.87) but higher likelihood of living donor transplantation (SHR, 1.14; 95% CI, 1.12 to 1.16) compared with those who received care at their nearest center. ETD was weakly associated with higher risk of graft failure.ConclusionsPatients who travel excess distances for transplant care have better access to living donor but not deceased donor transplantation and slightly higher risk of graft failure. Traveling excess distances is not clearly associated with better outcomes, especially if living donors are unavailable.

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Schold, Jesse D., Anne M. Huml, Emilio D. Poggio, John R. Sedor, Syed A. Husain, Kristin L. King, and Sumit Mohan. "Patients with High Priority for Kidney Transplant Who Are Not Given Expedited Placement on the Transplant Waiting List Represent Lost Opportunities." Journal of the American Society of Nephrology 32, no. 7 (June 17, 2021): 1733–46. http://dx.doi.org/10.1681/asn.2020081146.

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BackgroundKidney transplantation is associated with the best outcomes for most patients with ESKD. The national Kidney Allocation System prioritizes patients with Estimated Post-Transplant Survival (EPTS) scores in the top 20% for expedited access to optimal deceased donor kidneys.MethodsWe studied adults aged ≥18 years in the United States Renal Data System with top 20% EPTS scores who had been preemptively waitlisted or initiated dialysis in 2015–2017. We evaluated time to waitlist placement, transplantation, and mortality with unadjusted and multivariable survival models.ResultsOf 42,445 patients with top 20% EPTS scores (mean age, 38.0 years; 57% male; 59% White patients, and 31% Black patients), 7922 were preemptively waitlisted. Among 34,523 patients initiating dialysis, the 3-year cumulative waitlist placement incidence was 37%. Numerous factors independently associated with waitlisting included race, income, and having noncommercial insurance. For example, waitlisting was less likely for Black versus White patients, and for patients in the lowest-income neighborhoods versus those in the highest-income neighborhoods. Among patients initiating dialysis, 61% lost their top 20% EPTS status within 30 months versus 18% of patients who were preemptively listed. The 3-year incidence of deceased and living donor transplantation was 5% and 6%, respectively, for patients who initiated dialysis and 26% and 44%, respectively, for patients who were preemptively listed.ConclusionsMany patients with ESKDqualifying with top 20% EPTS status are not placed on the transplant waiting list in a timely manner, with significant variation on the basis of demographic and social factors. Patients who are preemptively listed are more likely to receive benefits of top 20% EPTS status. Efforts to expedite care for qualifying candidates are needed, and automated transplant referral for patients with the best prognoses should be considered.PodcastThis article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2021_07_30_JASN2020081146.mp3

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Gibbons, Andrea, Janet Bayfield, Marco Cinnirella, Heather Draper, Rachel J. Johnson, Gabriel C. Oniscu, Rommel Ravanan, et al. "Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews." BMJ Open 11, no. 4 (April 2021): e047263. http://dx.doi.org/10.1136/bmjopen-2020-047263.

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ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

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Adekunle, Ruth O., Rebecca Zhang, Zhensheng Wang, Rachel Patzer, and Aneesh Mehta. "1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S652—S653. http://dx.doi.org/10.1093/ofid/ofz360.1633.

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Abstract Background As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH had a three-fold increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. There are limited data on the incidence and prevalence of PLWH on dialysis. Our objective was to determine the incidence of PLWH on dialysis in ESRD Network 6 (GA, NC, SC) and assess their referral to kidney transplantation and waitlisting on the deceased donor waiting list. Methods We merged data from the Southeast Transplant Referral Dataset with the United States Renal Data System Medicare Part D Prescription Claims. PLWH were defined as having a prescription for antiretroviral medications or primary cause of ESRD being HIV-associated nephropathy. Descriptive analysis was performed using Student’s t-test for continuous variables and chi-squared test for categorical variables. Results The dataset contained 24,587 patients (471 HIV positive) that initiated an ESRD service between 2012 and 2015. Incidence of PLWH on dialysis was 1.92%. Compared with HIV negative persons, PLWH were younger (median age 49 vs. 58, P < 0.001) and more often black (90% vs. 57%, P < 0.001). There were similar rates of referral among PLWH and HIV-negative persons (50% vs. 51%, P = 0.81), though PLWH were statistical significantly less likely to be waitlisted (8% vs. 15%, P < 0.001). PLWH had longer median time to be referred (240 days vs. 147 days, P < 0.001) and waitlisted compared with HIV-negative persons (611 days vs. 420 days, P = 0.04). Conclusion This pilot study offers the first ESRD Network-level characterization of PLWH receiving an ESRD service proceeding through the steps of kidney transplantation. PLWH were less likely to traverse the steps of kidney transplant compared with those HIV negative, highlighting the need for targeted interventions to improve access to kidney transplant in PLWH. Disclosures All authors: No reported disclosures.

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Sheikhalipour, Zahra, Vahid Zamanzadeh, Leili Borimnejad, Leila Valizadeh, Sarah Newton, Mohammad Shahbazi, Afshar Zomorrodi, and Mojtaba Nazari. "The Effects of Religious and Cultural Beliefs on Muslim Transplant Candidates During the Pretransplant Waiting Period." Research and Theory for Nursing Practice 32, no. 1 (April 2018): 82–95. http://dx.doi.org/10.1891/1541-6577.32.1.82.

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Background:Awaiting organ transplantation can be stressful, and pretransplant candidates’ religious and cultural beliefs can influence how they adapt to the stress. While little is known about the effect religious and cultural beliefs have on the pretransplant waiting period, virtually nothing is known regarding whether and how Shia Muslim patients’ religious and cultural beliefs facilitate more positive patient outcomes while they await transplantation. Therefore, it is important for nurses and other health care providers to understand transplant candidates’ experiences dealing with the stressors that present themselves during the pretransplant waiting period, especially how their religious and cultural beliefs affect their adaptation to the stressors.Aim:The purpose of this study was to explore the lived experience of Shia Muslim organ transplant candidates regarding how their religious and cultural beliefs affect their adaptation to the pretransplant waiting period.Sample:A purposeful sample of 11 Shia Muslim organ transplant candidates who were on an organ transplant waiting list in Iran (kidney,n= 4; heart,n= 4; liver,n= 3) was recruited.Method:A qualitative research design using the hermeneutical phenomenological approach was utilized in this study. In-depth unstructured interviews were conducted by one of the authors (ZS) in different locations across Iran.Results:Data analysis led to the development of six themes: “the misty road of organ transplantation,” “to accede to organ transplantation despite religious conflict,” “one step away from death,” “the master key of liberation,” “fear of the unknown,” and “reliance on God.”Nursing Implications:The findings of this study will help nurses understand the religious and cultural meaning associated with stressors experienced by Shia Muslim patients awaiting organ transplant. This information can assist nurses to develop plans of care that include patient-specific interventions that take into consideration the patients’ religious and cultural beliefs.Conclusion:Shia Muslim patients awaiting organ transplantation experience feelings that are often in conflict with their religious and cultural beliefs. However, the patients’ reliance on God during the pretransplant waiting period facilitated healthier attitudes regarding transplantation.

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Mansouri, Imène, Natalia Alencar de Pinho, Renaud Snanoudj, Christian Jacquelinet, Mathilde Lassalle, Clémence Béchade, Cécile Vigneau, Florent de Vathaire, Nadia Haddy, and Bénédicte Stengel. "Trends and Outcomes with Kidney Failure from Antineoplastic Treatments and Urinary Tract Cancer in France." Clinical Journal of the American Society of Nephrology 15, no. 4 (March 6, 2020): 484–92. http://dx.doi.org/10.2215/cjn.10230819.

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Background and objectivesCancer survival is improving along with an increase in the potential for adverse kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of kidney failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and kidney transplantation access.Design, setting, participants, & measurementsWe used the French Renal Epidemiology and Information Network registry to identify patients with kidney failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer–related kidney failure, respectively. The main study outcomes were death and kidney transplantation. After matching cases to two to ten controls (n=11,678) with other kidney failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy.ResultsThe mean age- and sex-adjusted incidence of nephrotoxin-related kidney failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer–related kidney failure; they increased significantly by 5% and 2% annually, respectively, during 2006–2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related kidney failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related kidney failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls.ConclusionsCancer-related kidney failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to kidney transplant remains limited.

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Schappe, Tyler, Sarah Peskoe, Nrupen Bhavsar, L. Ebony Boulware, Jane Pendergast, and Lisa M. McElroy. "Geospatial Analysis of Organ Transplant Referral Regions." JAMA Network Open 5, no. 9 (September 15, 2022): e2231863. http://dx.doi.org/10.1001/jamanetworkopen.2022.31863.

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ImportanceSystem and center-level interventions to improve health equity in organ transplantation benefit from robust characterization of the referral population served by each transplant center. Transplant referral regions (TRRs) define geographic catchment areas for transplant centers in the US, but accurately characterizing the demographics of populations within TRRs using US Census data poses a challenge.ObjectiveTo compare 2 methods of linking US Census data with TRRs—a geospatial intersection method and a zip code cross-reference method.Design, Setting, and ParticipantsThis cohort study compared spatial congruence of spatial intersection and zip code cross-reference methods of characterizing TRRs at the census block level. Data included adults aged 18 years and older on the waiting list for kidney transplant from 2008 through 2018.ExposuresEnd-stage kidney disease.Main Outcomes and MeasuresMultiple assignments, where a census tract or block group crossed the boundary between 2 hospital referral regions and was assigned to multiple different TRRs; misassigned area, the portion of census tracts or block groups assigned to a TRR using either method but fall outside of the TRR boundary.ResultsIn total, 102 TRRs were defined for 238 transplant centers. The zip code cross-reference method resulted in 4627 multiple-assigned census block groups (representing 18% of US land area assigned to TRRs), while the spatial intersection method eliminated this problem. Furthermore, the spatial method resulted in a mean and median reduction in misassigned area of 65% and 83% across all TRRs, respectively, compared with the zip code cross-reference method.Conclusions and RelevanceIn this study, characterizing populations within TRRs with census block groups provided high spatial resolution, complete coverage of the country, and balanced population counts. A spatial intersection approach avoided errors due to duplicative and incorrect assignments, and allowed more detailed and accurate characterization of the sociodemographics of populations within TRRs; this approach can enrich transplant center knowledge of local referral populations, assist researchers in understanding how social determinants of health may factor into access to transplant, and inform interventions to improve heath equity.

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Amaral, Sandra, Charles E. McCulloch, Feng Lin, Barbara A. Grimes, Susan Furth, Bradley Warady, Celina Brunson, Salpi Siyahian, and Elaine Ku. "Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US." JAMA 328, no. 5 (August 2, 2022): 451. http://dx.doi.org/10.1001/jama.2022.11231.

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John, Devon G., Laura Museau, Nabil Sumrani, Hiroshi Sogawa, Seigo Nishida, and Thomas Diflo. "Center Petitioning of the Us Department of State Increases Access to Living Kidney Donation for Legal Immigrants and Naturalized Citizens on the Transplant Waiting List." Journal of the American College of Surgeons 233, no. 5 (November 2021): e198-e199. http://dx.doi.org/10.1016/j.jamcollsurg.2021.08.536.

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Erdem, Emre, Ahmet Karatas, and Tevfik Ecder. "Factors Affecting Registration on Kidney Transplant Waiting List." Turkish Journal of Nephrology 28, no. 4 (November 5, 2019): 280–85. http://dx.doi.org/10.5152/turkjnephrol.2019.3557.

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Lorenz, Elizabeth C., Fernando G. Cosio, Shari L. Bernard, Steven D. Bogard, Brian R. Bjerke, Elizabeth N. Geissler, Steven W. Hanna, et al. "The Relationship Between Frailty and Decreased Physical Performance With Death on the Kidney Transplant Waiting List." Progress in Transplantation 29, no. 2 (March 17, 2019): 108–14. http://dx.doi.org/10.1177/1526924819835803.

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Introduction: Frailty and decreased physical performance are associated with poor outcomes after kidney transplant. Less is known about their relationship with pretransplant outcomes. The aim of this study was to characterize associations between frailty and physical performance with death on the kidney transplant waiting list. Design: Since December 2014, high-risk kidney transplant candidates at our center (age > 59, diabetic and/or history of >3 years dialysis) have undergone frailty and physical performance testing using Fried Criteria and the Short Physical Performance Battery. Results: Between December 2014 and November 2016, 272 high-risk candidates underwent testing and were approved for transplant. Both frailty and physical performance score were significantly associated with death on the waiting list (hazard ratio [HR]: 6.7, confidence interval [CI]: 1.5-30.1; P = .01; HR: 0.8 per 1-point increase, CI: 0.7-1.0; P = .02, respectively). The relationship between frailty, physical performance score, and death on the waiting list appeared to be independent of age, diabetes, or duration of dialysis. Discussion: Frailty and decreased physical performance appear to be independently associated with increased mortality on the kidney transplant waiting list. Further studies are needed to determine whether improving frailty and physical performance prior to transplant can decrease waiting list mortality.

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Ong, Siew Chin, Wai Leng Chow, Saskia van der Erf, Veena Dhanajay Joshi, Jeremy FY Lim, Crystal Lim, Ping Sing Tee, York Moi Lu, and Terence YS Kee. "What Factors Really Matter? Health-related Quality of Life for Patients on Kidney Transplant Waiting List." Annals of the Academy of Medicine, Singapore 42, no. 12 (December 15, 2013): 657–66. http://dx.doi.org/10.47102/annals-acadmedsg.v42n12p657.

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Introduction: Waiting times for kidney transplant are long in Singapore. Health-related quality of life (HRQoL) of patients might be affected as a result of the stress of the long wait and the uncertainty of being called to undergo a surgical operation. This study aimed to measure the HRQoL of patients on the kidney transplant waiting list and to identify factors which could impact on the HRQoL scores in this group of patients.Materials and Methods: This was a cross-sectional study of kidney transplant waiting list patients managed at a tertiary renal unit using the SF-36. A SF-36 normative calculator was used to generate HRQoL scores for the Singapore general population matched with the study cohort’s age, gender and ethnicity. Results: There were 265 respondents with a response rate was 81%. Our study shows that HRQoL scores for the kidney transplant waiting list patients were lower than the population norms across all subscales and were clinically significant for General Health, Role Physical, Bodily Pain, Social Functioning and Mental Component Summary scores. Factors such as being Chinese, married, employed and undergoing haemodialysis predicted better HRQoL scores after adjusting for possible confounders. Age, gender, educational level, household income, history of kidney transplant, duration on the transplant waiting list and years on dialysis did not significantly influence SF-36 across all subscales scores. Conclusion: Kidney transplant waiting list patients had worse HRQoL compared to the general population. Factors such as ethnicity, marital status, employment status, and type of dialysis treatment significantly influenced patients’ perception of their HRQoL. Key words: Dialysis, Kidney failure patients, SF-36

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Rocha, Sofia G., Nihil Chitalia, Helen Gregson, Juan C. Kaski, Rajan Sharma, and Debasish Banerjee. "Echocardiographic abnormalities in patients on kidney transplant waiting list." Journal of Nephrology 25, no. 6 (2012): 1119–25. http://dx.doi.org/10.5301/jn.5000103.

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Brito, André Thiago Scandiuzzi, Luiz Sergio Azevedo, Willian Carlos Nahas, André Siqueira Matheus, and José Jukemura. "Cholelithiasis in patients on the kidney transplant waiting list." Clinics 65, no. 4 (2010): 389–91. http://dx.doi.org/10.1590/s1807-59322010000400007.

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Maghen, Ariella, Thomas D. Mone, and Jeffrey Veale. "The Kidney-Transplant Waiting List and the Opioid Crisis." New England Journal of Medicine 380, no. 23 (June 6, 2019): 2273–74. http://dx.doi.org/10.1056/nejmc1817188.

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Kiberd, B., J. Boudreault, V. Bhan, and R. Panek. "Access to the Kidney Transplant Wait List." American Journal of Transplantation 6, no. 11 (November 2006): 2714–20. http://dx.doi.org/10.1111/j.1600-6143.2006.01523.x.

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Charoenthanakit, C., P. Junchotikul, R. Sittiudomsuk, A. Saiyud, and P. Pratumphai. "Effectiveness of Multimedia for Transplant Preparation for Kidney Transplant Waiting List Patients." Transplantation Proceedings 48, no. 3 (April 2016): 773–74. http://dx.doi.org/10.1016/j.transproceed.2016.02.042.

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Sullivan, Catherine M., Kitty V. Barnswell, Kate Greenway, Cindy M. Kamps, Derrick Wilson, Jeffrey M. Albert, Jacqueline Dolata, et al. "Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation." Clinical Journal of the American Society of Nephrology 13, no. 10 (August 22, 2018): 1550–55. http://dx.doi.org/10.2215/cjn.03100318.

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Background and objectivesMany patients with ESKD face barriers in completing the steps required to obtain a transplant. These eight sequential steps are medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on helping patients complete these steps.Design, setting, participants, & measurementsOur study was a cluster randomized, controlled trial involving 40 hemodialysis facilities and four transplant centers in Ohio, Kentucky, and Indiana from January 1, 2014 to December 31, 2016. Four trained kidney transplant recipients met regularly with patients on hemodialysis at 20 intervention facilities, determined their step in the transplant process, and provided tailored information and assistance in completing that step and subsequent steps. Patients at 20 control facilities continued to receive usual care. Primary study outcomes were waiting list placement and receipt of a deceased or living donor transplant. An exploratory outcome was first visit to a transplant center.ResultsBefore the trial, intervention (1041 patients) and control (836 patients) groups were similar in the proportions of patients who made a first visit to a transplant center, were placed on a waiting list, and received a deceased or living donor transplant. At the end of the trial, intervention and control groups were also similar in first visit (16.1% versus 13.8%; difference, 2.3%; 95% confidence interval, −0.8% to 5.5%), waitlisting (16.3% versus 13.8%; difference, 2.5%; 95% confidence interval, −1.2% to 6.1%), deceased donor transplantation (2.8% versus 2.2%; difference, 0.6%; 95% confidence interval, −0.8% to 2.1%), and living donor transplantation (1.2% versus 1.0%; difference, 0.1%; 95% confidence interval, −0.9% to 1.1%).ConclusionsUse of trained kidney transplant recipients as navigators did not increase first visits to a transplant center, waiting list placement, and receipt of deceased or living donor transplants.

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Battaglia, Yuri, Elena Martino, Giulia PIazza, Sara Massarenti, Luana Peron, Alda Storari, and Luigi Grassi. "MP777DCPR SYNDROMES IN KIDNEY TRANSPLANT RECIPIENTS AND IN PATIENTS ON WAITING LIST FOR KIDNEY TRANSPLANT." Nephrology Dialysis Transplantation 32, suppl_3 (May 1, 2017): iii718—iii719. http://dx.doi.org/10.1093/ndt/gfx182.mp777.

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Miles, Clifford D., Scott Westphal, AnnMarie Liapakis, and Richard Formica. "Simultaneous Liver-Kidney Transplantation: Impact on Liver Transplant Patients and the Kidney Transplant Waiting List." Current Transplantation Reports 5, no. 1 (January 19, 2018): 1–6. http://dx.doi.org/10.1007/s40472-018-0175-z.

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Cechlárová, Katarína, Martina Hančová, Diana Plačková, and Tatiana Baltesová. "Stochastic modelling and simulation of a kidney transplant waiting list." Central European Journal of Operations Research 29, no. 3 (March 30, 2021): 909–31. http://dx.doi.org/10.1007/s10100-021-00742-9.

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Sabouri, Alireza, Woonghee Tim Huh, and Steven M. Shechter. "Screening Strategies for Patients on the Kidney Transplant Waiting List." Operations Research 65, no. 5 (October 2017): 1131–46. http://dx.doi.org/10.1287/opre.2017.1632.

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Gámez, Bernabé Jurado, Alejandro Martín-Malo, Mari Carmen Fernández Marín, Alberto Rodríguez-Benot, Natalia Pascual, Luis Muñoz Cabrera, and Pedro Aljama. "Sleep Disorders in Patients on a Kidney Transplant Waiting List." Archivos de Bronconeumología ((English Edition)) 44, no. 7 (January 2008): 371–75. http://dx.doi.org/10.1016/s1579-2129(08)60065-8.

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Tenenbaum, Evelyn M. "Swaps and Chains and Vouchers, Oh My!: Evaluating How Saving More Lives Impacts the Equitable Allocation of Live Donor Kidneys." American Journal of Law & Medicine 44, no. 1 (March 2018): 67–118. http://dx.doi.org/10.1177/0098858818763812.

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Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice.This article traces the progression of innovations created to make optimum use of a patient's own live donors. It starts with the simplest – direct donation by family members – and ends with voucher donations, a very recent and unique innovation because the donor can donate 20 or more years before the intended recipient is expected to need a kidney. In return for the donation, the intended recipient receives a voucher that can be redeemed for a live kidney when it is needed. Other innovations that are discussed include kidney exchanges and list paired donation, which are used to facilitate donor swaps when donor/recipient pairs have incompatible blood types.The discussion of each new innovation shows how the equity issues build on each other and how, with each new innovation, it becomes progressively harder to find an acceptable balance between utility and justice. The article culminates with an analysis of two recent allocation methods that have the potential to save many additional lives, but also affirmatively harm some patients on the deceased donor waiting list by increasing their waiting time for a life-saving kidney. The article concludes that saving additional lives does not justify harming patients on the waiting list unless that harm can be minimized. It also proposes solutions to minimize the harm so these new innovations can equitably perform their intended function of stimulating additional transplants and extending the lives of many transplant patients.

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Novotny, R., J. Chlupac, T. Marada, S. Bloudickova-Rajnochova, H. Vavrinova, L. Janousek, and J. Fronek. "Deceased Donor Renal Transplantation Combined with Bilateral Nephrectomy in a Patient with Tuberous Sclerosis and Renal Failure." Case Reports in Transplantation 2019 (March 6, 2019): 1–5. http://dx.doi.org/10.1155/2019/2172163.

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Introduction. A 27-year-old female patient with known tuberous sclerosis complex (TSC), polycystic kidneys with multiple large bilateral angiomyolipomas, and failing renal functions with prehemodialysis values (urea: 19 mmol/L; creatinine: 317 μmol/L; CKD-EPI 0,27) was admitted to our department for pre-renal transplant evaluation. The patient was placed on the transplant waiting list as the living donor did not pass pretransplant workup and was subsequently contraindicated. Patient was placed on the “cadaverous kidney transplant waiting list”. Method. Computed tomography angiography revealed symptomatic PSA in the right kidney angiomyolipoma (AML). The patient underwent urgent transarterial embolisation of the PSA’s feeding vessel in the right kidney AML. Based on the “kidney transplant waiting list” order patient underwent a bilateral nephrectomy combined with transperitoneal renal allotransplantation of a cadaverous kidney graft through midline laparotomy, appendectomy, and cholecystectomy. Results. Postoperative period was complicated by delayed graft function caused by acute tubular necrosis requiring postoperative hemodialysis. The patient was discharged on the 17th postoperative day with a good renal graft function. Patient’s follow-up is currently 23 months with good graft function (urea: 9 mmol/L; creatinine: 100 μmol/L). Conclusion. Renal transplantation combined with radical nephrectomy provides a definitive treatment for TSC renal manifestations.

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Sapiertein Silva, Juliana Feiman, Gustavo Fernandes Ferreira, Marcelo Perosa, Hong Si Nga, and Luis Gustavo Modelli de Andrade. "A machine learning prediction model for waiting time to kidney transplant." PLOS ONE 16, no. 5 (May 20, 2021): e0252069. http://dx.doi.org/10.1371/journal.pone.0252069.

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Background Predicting waiting time for a deceased donor kidney transplant can help patients and clinicians to discuss management and contribute to a more efficient use of resources. This study aimed at developing a predictor model to estimate time on a kidney transplant waiting list using a machine learning approach. Methods A retrospective cohort study including data of patients registered, between January 1, 2000 and December 31, 2017, in the waiting list of São Paulo State Organ Allocation System (SP-OAS) /Brazil. Data were randomly divided into two groups: 75% for training and 25% for testing. A Cox regression model was fitted with deceased donor transplant as the outcome. Sensitivity analyses were performed using different Cox models. Cox hazard ratios were used to develop the risk-prediction equations. Results Of 54,055 records retrieved, 48,153 registries were included in the final analysis. During the study period, approximately 1/3 of the patients were transplanted with a deceased donor. The major characteristics associated with changes in the likelihood of transplantation were age, subregion, cPRA, and frequency of HLA-DR, -B and -A. The model developed was able to predict waiting time with good agreement in internal validation (c-index = 0.70). Conclusion The kidney transplant waiting time calculator developed shows good predictive performance and provides information that may be valuable in assisting candidates and their providers. Moreover, it can significantly improve the use of economic resources and the management of patient care before transplant.

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Bhatti, Ahsin Manzoor, Anum Arif, Mannan Masud, Khalid Siddique, Ali Saeed, and Amjad Khan. "Chronic Kidney Disease Patients: Collateral Damage Due to Suspension of Vascular Access Services." Pakistan Armed Forces Medical Journal 72, no. 5 (November 7, 2022): 1847–49. http://dx.doi.org/10.51253/pafmj.v72i5.5684.

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This study was conducted at the Department of Vascular Surgery at Combined Military Hospital Lahore from December 2019to June 2020. The mortality of patients on the waiting list for vascular access in our institution three months afterimplementing strict policies for elective surgeries (30th March 2020 to 29th June 2020) was compared with the preceding threemonths. The mortality of patients in the pre-COVID-19 periods on the waiting list for HD was 11 (7.9%) in the pre-COVID-19 period, while this increased to 5 (12.5%) in the post-COVID-19 period. COVID-19 related suspension of vascular access services negatively influences CKD patients waiting for permanent vascular access.

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Kainz, Alexander, Michael Kammer, Roman Reindl-Schwaighofer, Susanne Strohmaier, Vojtěch Petr, Ondrej Viklicky, Daniel Abramowicz, Marcel Naik, Gert Mayer, and Rainer Oberbauer. "Waiting Time for Second Kidney Transplantation and Mortality." Clinical Journal of the American Society of Nephrology 17, no. 1 (December 29, 2021): 90–97. http://dx.doi.org/10.2215/cjn.07620621.

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Background and objectivesThe median kidney transplant half-life is 10–15 years. Because of the scarcity of donor organs and immunologic sensitization of candidates for retransplantation, there is a need for quantitative information on if and when a second transplantation is no longer associated with a lower risk of mortality compared with waitlisted patients treated by dialysis. Therefore, we investigated the association of time on waiting list with patient survival in patients who received a second transplantation versus remaining on the waiting list.Design, setting, participants, & measurementsIn this retrospective study using target trial emulation, we analyzed data of 2346 patients from the Austrian Dialysis and Transplant Registry and Eurotransplant with a failed first graft, aged over 18 years, and waitlisted for a second kidney transplantation in Austria during the years 1980–2019. The differences in restricted mean survival time and hazard ratios for all-cause mortality comparing the treatment strategies “retransplant” versus “remain waitlisted with maintenance dialysis” are reported for different waiting times after first graft loss.ResultsSecond kidney transplantation showed a longer restricted mean survival time at 10 years of follow-up compared with remaining on the waiting list (5.8 life months gained; 95% confidence interval, 0.9 to 11.1). This survival difference was diminished in patients with longer waiting time after loss of the first allograft; restricted mean survival time differences at 10 years were 8.0 (95% confidence interval, 1.9 to 14.0) and 0.1 life months gained (95% confidence interval, −14.3 to 15.2) for patients with waiting time for retransplantation of <1 and 8 years, respectively.ConclusionsSecond kidney transplant is associated with patient survival compared with remaining waitlisted and treatment by dialysis, but the survival difference diminishes with longer waiting time.

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Hernández, Domingo, Juana Alonso-Titos, Ana Maria Armas-Padrón, Veronica Lopez, Mercedes Cabello, Eugenia Sola, Laura Fuentes, et al. "Waiting List and Kidney Transplant Vascular Risk: An Ongoing Unmet Concern." Kidney and Blood Pressure Research 45, no. 1 (December 4, 2019): 1–27. http://dx.doi.org/10.1159/000504546.

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Background: Chronic kidney disease (CKD) is an important independent risk factor for adverse cardiovascular events in patients waitlisted for kidney transplantation (KT). Although KT reduces cardiovascular risk, these patients still have a higher all-cause and cardiovascular mortality than the general population. This concerning situation is due to a high burden of traditional and nontraditional risk factors as well as uremia-related factors and transplant-specific factors, leading to 2 differentiated processes under the framework of CKD, atherosclerosis and arteriosclerosis. These can be initiated by insults to the vascular endothelial endothelium, leading to vascular calcification (VC) of the tunica media or the tunica intima, which may coexist. Several pathogenic mechanisms such as inflammation-related endothelial dysfunction, mineral metabolism disorders, activation of the renin-angiotensin system, reduction of nitric oxide, lipid disorders, and the fibroblast growth factor 23-klotho axis are involved in the pathogenesis of atherosclerosis and arteriosclerosis, including VC. Summary: This review focuses on the current understanding of atherosclerosis and arteriosclerosis, both in patients on the waiting list as well as in kidney transplant recipients, emphasizing the cardiovascular risk factors in both populations and the inflammation-related pathogenic mechanisms. Key Message: The importance of cardiovascular risk factors and the pathogenic mechanisms related to inflammation in patients waitlisted for KT and kidney transplant recipients.

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Dudley, Christopher R. K., Rachel J. Johnson, Helen L. Thomas, Rommel Ravanan, and David Ansell. "Factors That Influence Access to the National Renal Transplant Waiting List." Transplantation 88, no. 1 (July 2009): 96–102. http://dx.doi.org/10.1097/tp.0b013e3181aa901a.

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Lopes, Soraia Geraldo Rozza, and Denise Maria Guerreiro Vieira da Silva. "Narratives of women on hemodialysis: waiting for a kidney transplant." Texto & Contexto - Enfermagem 23, no. 3 (September 2014): 680–87. http://dx.doi.org/10.1590/0104-07072014002540013.

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The objective of this study was to understand the meanings of waiting for a kidney transplant for women on hemodialysis. This is a qualitative, interpretive study, conducted with 12 women on hemodialysis in the metropolitan region of Florianópolis. Data were collected through in-depth interviews at the homes of the participants. Ethnograph 6.0 software was used for pre-coding and interpretative analysis was done subsequently, from which two categories emerged. The first, "the shadows of the present moment," showed that the initial difficulties of the disease are present, but women can cope better with the disease and treatment. The second category, "the light of renal transplantation", shows the hope fostered by entry on the waiting list for a transplant.

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Journal articles on the topic 'Access to waiting list and kidney transplant'

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