Journal articles: 'Kidney transplant waiting list'

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Minina, M. G., N. A. Ignatov, and S. B. Truhmanov. "Mathematical аnalysis of kidney transplant demand and availability." Russian Journal of Transplantology and Artificial Organs 19, no. 4 (January 30, 2018): 27–33. http://dx.doi.org/10.15825/1995-1191-2017-4-27-33.

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Aim. To analyse the dynamics of the need and availability of donor kidneys for transplantation. To construct the predictions for the number of waiting lists. To analyse the annual number of kidney transplants and the availability ofdonor kidney.Materials and methods. Data base of Eurotransplant International Foundation 1969–2015 has been analyzed. We built a forecast of the kidney waiting list, kidney transplants quantity and availability of kidney grafts up to 2030.Results. Random process analysis of kidney transplant recipients number has shown an increasing linear trend. Growing linear trend is due to the inability to fully meet the increasing need for a kidney transplant. Presence of a regular stochastic component is revealed that provides random ﬂ uctuations in the number of patients waiting for kidney transplantation with a period of 35–40 years. Random process of the number of kidney transplants showed an exponential asymptotic trend growing to a certain saturation value. Estimation of its autocorrelation function showed the absence of regular stochastic components in it. Preservation of 1969–2015 dynamics for the period 2015–2030 allows to suggest a signiﬁ cant increase in the number of people waiting for transplant and a decrease in the availability of donor kidneys.Conclusion. The number of donor kidney transplantations tends to saturation limit, and limit is already lower than the current need for donor kidneys. The increase in the number of kidney transplantation programs and the improvement of organ donation system may lead to a limited increase in annual number of transplants and, possibly, the saturation limit, but not to a qualitative change in the dynamics of reduced availability of donor kidneys. A qualitative change in this dynamics towards increasing accessibility, is possible perhaps through activities that affect factors causing a constant increase in the number of people who need a transplant.

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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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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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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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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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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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Maccarone, D., I. Parzanese, L. Caniglia, F. Pisani, C. Cervelli, F. Papola, M. A. Fioroni, A. Famulari, and D. Adorno. "Waiting List for Kidney Transplants." Transplantation Proceedings 37, no. 6 (July 2005): 2419–20. http://dx.doi.org/10.1016/j.transproceed.2005.06.023.

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Mekeel, Kristin L., Shane M. Daley, Paul E. Andrews, Adyr A. Moss, R. L. Heilman, Marek J. Mazur, Harini A. Chakkera, Khalid Hamawi, David C. Mulligan, and K. Sudhakar Reddy. "Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease." Journal of Transplantation 2010 (2010): 1–5. http://dx.doi.org/10.1155/2010/383972.

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Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function.

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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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Cooper, David K. C., Hidetaka Hara, Hayato Iwase, Takayuki Yamamoto, Abhijit Jagdale, Vineeta Kumar, Roslyn Bernstein Mannon, Michael J. Hanaway, Douglas J. Anderson, and Devin E. Eckhoff. "Clinical Pig Kidney Xenotransplantation: How Close Are We?" Journal of the American Society of Nephrology 31, no. 1 (December 2, 2019): 12–21. http://dx.doi.org/10.1681/asn.2019070651.

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Patients with ESKD who would benefit from a kidney transplant face a critical and continuing shortage of kidneys from deceased human donors. As a result, such patients wait a median of 3.9 years to receive a donor kidney, by which time approximately 35% of transplant candidates have died while waiting or have been removed from the waiting list. Those of blood group B or O may experience a significantly longer waiting period. This problem could be resolved if kidneys from genetically engineered pigs offered an alternative with an acceptable clinical outcome. Attempts to accomplish this have followed two major paths: deletion of pig xenoantigens, as well as insertion of “protective” human transgenes to counter the human immune response. Pigs with up to nine genetic manipulations are now available. In nonhuman primates, administering novel agents that block the CD40/CD154 costimulation pathway, such as an anti-CD40 mAb, suppresses the adaptive immune response, leading to pig kidney graft survival of many months without features of rejection (experiments were terminated for infectious complications). In the absence of innate and adaptive immune responses, the transplanted pig kidneys have generally displayed excellent function. A clinical trial is anticipated within 2 years. We suggest that it would be ethical to offer a pig kidney transplant to selected patients who have a life expectancy shorter than the time it would take for them to obtain a kidney from a deceased human donor. In the future, the pigs will also be genetically engineered to control the adaptive immune response, thus enabling exogenous immunosuppressive therapy to be significantly reduced or eliminated.

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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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Gatter, Robert. "Commentary." Cambridge Quarterly of Healthcare Ethics 8, no. 3 (July 1999): 377–78. http://dx.doi.org/10.1017/s0963180199243150.

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This case is not about whether retransplant candidates should receive organs over first-time candidates, or whether risks of transplant failure from psychological or social factors are relevant to allocating organs. Rather, it concerns only this patient's qualifications to wait for a kidney transplant. Should the patient's prior transplants, noncompliance, and poor social network exclude her even from the waiting list? Do attending physicians inappropriately favor their patients over all others in need of transplants just by listing them? The answers turn on the difference between identifying a transplant need and allocating an organ.

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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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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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Howard, David H. "Producing Organ Donors." Journal of Economic Perspectives 21, no. 3 (July 1, 2007): 25–36. http://dx.doi.org/10.1257/jep.21.3.25.

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Organ transplantation is one of the greatest technological achievements of modern medicine, but the ability of patients to benefit from transplantation is limited by shortages of transplantable organs. The median waiting time for patients placed on the kidney transplant waiting list is over three years. Median waiting times for hearts and livers are seven months and two years, respectively. From 1995 to 2005, the number of patients placed on the waiting list for organ transplants grew at an annualized rate of 4 percent per year. As a result of the growth in the demand for organs, many observers have questioned whether the current system is capable of providing enough transplantable organs. Transplant physicians and policymakers are seriously debating proposals to pay donors and their families and to change the legal regime governing the process of obtaining consent to donation. This paper provides an overview of the rules and practices that govern the organ procurement system and reviews proposals to increase donation rates, with a focus on deceased donors.

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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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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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OJO, AKINLOLU O., JULIE A. HANSON, HERWIG-ULF MEIER-KRIESCHE, CHIKE N. OKECHUKWU, ROBERT A. WOLFE, ALAN B. LEICHTMAN, LAWRENCE Y. AGODOA, BRUCE KAPLAN, and FRIEDRICH K. PORT. "Survival in Recipients of Marginal Cadaveric Donor Kidneys Compared with Other Recipients and Wait-Listed Transplant Candidates." Journal of the American Society of Nephrology 12, no. 3 (March 2001): 589–97. http://dx.doi.org/10.1681/asn.v123589.

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Abstract. An increasing number of cadaveric kidney transplants are now performed with organs from donors who would have been deemed unsuitable in earlier times. Although good allograft outcomes have been obtained with these marginal donor transplants, it is unclear whether recipients of marginal kidney transplants achieve a reduction in long-term mortality as do recipients of “ideal” kidneys. Patients with end-stage renal disease registered on the cadaveric renal transplant waiting list between January 1, 1992, and June 30, 1997, were studied for mortality risks according to three outcomes: wait-listed on dialysis treatment with no transplant (WLD); transplantation with marginal donor kidney (MDK); and “ideal” or optimal donor kidney transplantation (IDK). Thirty-four percent of wait-list registrants had received a cadaveric kidney transplant by June 30, 1998. Of these, 18% received a marginal kidney that had one or more of the following pretransplant factors: donor age >55 yr, non-heartbeating donor, cold ischemia time >36 h, and donor hypertension or diabetes mellitus of > 10 yr duration. Five-year graft and patient survival was 53% and 74% for MDK recipients compared with 67% (P < 0.001) and 80% (P < 0.001) for IDK recipients. Adjusted annual death rate and estimated remaining life time was 6.3%, 4.7%, and 3.3% and 15.3 yr, 20.4 yr, and 28.7 yr for WLD, MDK, and IDK groups, respectively. The average increase in life expectancy for MDK recipients compared with the WLD cohort was 5 yr, although this benefit varied from 3 to 10 yr depending on the recipient's characteristics. It is concluded that transplantation of a marginal kidney is associated with a significant survival benefit when compared with maintenance dialysis.

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Danovitch, Gabriel M., Sundaram Hariharan, John D. Pirsch, David Rush, David Roth, Emilio Ramos, Randall C. Starling, Chuck Cangro, and Mattthew R. Weir. "Management of the Waiting List for Cadaveric Kidney Transplants: Report of a Survey and Recommendations by the Clinical Practice Guidelines Committee of the American Society of Transplantation." Journal of the American Society of Nephrology 13, no. 2 (February 2002): 528–35. http://dx.doi.org/10.1681/asn.v132528.

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ABSTRACT. The Clinical Practice Guidelines Committee of the American Society of Transplantation developed a survey to review the policies of kidney transplant programs in the United States with respect to the management of the steadily expanding waiting list for cadaveric kidneys. The survey was sent to 287 centers, and 192 (67%) responded. The survey indicated that regular follow-up monitoring, most frequently on an annual basis, is required by the majority (71%) of programs. Patients considered to be at high risk and candidates for combined kidney-pancreas transplantation may be monitored more frequently. Annual screening for coronary artery disease is typically required for asymptomatic patients considered to be at high risk for covert disease. Noninvasive techniques are typically used, and a designated cardiologist is usually available to the transplant program. The dialysis nephrologist or the potential transplant recipient is expected to inform the transplant program of intercurrent events that may affect transplant candidacy. Standard health maintenance screening is required, together with the routine updating of serologic and other blood tests that may be relevant to the posttransplant course. Smaller transplant programs (<100 patients on the waiting list) are more likely to maintain closer contact with the wait-listed patients and to attempt to influence their treatment during dialysis and are less likely to cancel transplants because of unanticipated pretransplant medical problems. The work load necessitated by the follow-up monitoring of wait-listed patients was assessed and, in the absence of specific evidence-based information, a series of recommendations were developed to reflect current standards of practice and to suggest future research initiatives.

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Anderson, Ross, Itai Ashlagi, David Gamarnik, and Alvin E. Roth. "Finding long chains in kidney exchange using the traveling salesman problem." Proceedings of the National Academy of Sciences 112, no. 3 (January 5, 2015): 663–68. http://dx.doi.org/10.1073/pnas.1421853112.

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As of May 2014 there were more than 100,000 patients on the waiting list for a kidney transplant from a deceased donor. Although the preferred treatment is a kidney transplant, every year there are fewer donors than new patients, so the wait for a transplant continues to grow. To address this shortage, kidney paired donation (KPD) programs allow patients with living but biologically incompatible donors to exchange donors through cycles or chains initiated by altruistic (nondirected) donors, thereby increasing the supply of kidneys in the system. In many KPD programs a centralized algorithm determines which exchanges will take place to maximize the total number of transplants performed. This optimization problem has proven challenging both in theory, because it is NP-hard, and in practice, because the algorithms previously used were unable to optimally search over all long chains. We give two new algorithms that use integer programming to optimally solve this problem, one of which is inspired by the techniques used to solve the traveling salesman problem. These algorithms provide the tools needed to find optimal solutions in practice.

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Battaglia, Yuri, Luigi Zerbinati, Elena Martino, Giulia Piazza, Sara Massarenti, Alda Storari, and Luigi Grassi. "Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data." Transplantology 1, no. 2 (December 15, 2020): 123–34. http://dx.doi.org/10.3390/transplantology1020012.

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Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.

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MEIER-KRIESCHE, HERWIG-ULF, AKINLOLU O. OJO, FRIEDRICH K. PORT, JULIE A. ARNDORFER, DIANE M. CIBRIK, and BRUCE KAPLAN. "Survival Improvement among Patients with End-Stage Renal Disease: Trends over Time for Transplant Recipients and Wait-Listed Patients." Journal of the American Society of Nephrology 12, no. 6 (June 2001): 1293–96. http://dx.doi.org/10.1681/asn.v1261293.

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Abstract. Both transplant and dialysis outcomes have improved over recent years. In addition, transplantation has been shown to confer a survival benefit over maintenance dialysis. The study presented here addresses the question of whether the survival benefit of transplantation over maintenance dialysis has changed in the most recent eras. This study was based on data collected by the United States Renal Transplant Scientific Registry and the United States Renal Data System. The study sample consisted of 104,000 patients placed on the renal transplant waiting list between 1988 and 1996, of which 73,707 subsequently received renal transplants. The annualized adjusted mortality rates per 1000 patient-years were calculated by calendar year of placement on the renal transplant waiting list and for kidney transplant recipients. The resulting data were plotted, and linear curve fitting was used to estimate the slope of the change of the adjusted mortality rates by year during the period studied, 1988 to 1996. Overall annual adjusted death rates in the wait-listed patients and transplant recipients per 1000 patient-years decreased for both groups throughout the study period. From 1989 to 1996, the relative risk (RR) for patient death had decreased by 30% for transplant recipients and 23% for wait-listed patients (RR = 0.70 and 0.77; P < 0.0001 each). Slope analysis of the cause-specific mortality rates for cardiovascular disease and infection showed nearly equivalent, linear decreases for both groups. Mortality rates have improved overall and by categories of major cause of death for both renal transplant recipients and patients on the renal transplant waiting list. These favorable trends most likely represent equal advances in transplantation, dialysis, and general medical care.

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Forni Ogna, V., A. Ogna, J. Haba-Rubio, and R. Heinzer. "0699 Effect Of Kidney Transplantation On Sleep Apnea Severity: A Prospective Controlled Polysomnographic Study." Sleep 43, Supplement_1 (April 2020): A266—A267. http://dx.doi.org/10.1093/sleep/zsaa056.695.

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Abstract Introduction Renal failure-associated fluid overload has been associated with a high prevalence of sleep apnea (SA) in patients with end-stage kidney disease (ESKD). Kidney transplantation has been shown to restore a normal renal function but its effect on SA remains unclear. In this prospective study, we hypothesized that improvement of kidney function and hydration status after kidney transplantation (Tx) may result in an improvement of SA severity. Methods A total of 196 patients on kidney transplant waiting list were screened for SA using home nocturnal polysomnography (PSG) to measure the Apnea-Hypopnea Index (AHI) and underwent bioimpedance to assess body composition. Polysomnography and bioimpedance were repeated 6 months after kidney transplant. Patients still on the waiting list after 6 months underwent same investigations as a control group. Results Of 88 participants (44.9%) with SA (AHI ≥15/h) at baseline, 42 patients were reassessed 6 months post-Tx and were compared to 27 control patients remaining on the waiting list after 6 months. There was a significant, although partial, post-Tx improvement in SA severity as measured by the AHI (from 44.2±24.3/h to 34.7±20.9/h, p=0.02), with a concomitant reduction in body water (from 54.9% to 51.6%, p=0.003), suggesting a causal implication of fluid overload. A post-Tx increase in body fat mass (from 26% to 30%, p=0.003) may have blunted the beneficial impact of kidney Tx on SA. These parameters remained unchanged in the control group. Conclusion SA is a frequent condition in ESKD patients. Kidney transplantation is associated with a reduction of fluid overload but an increase in fat mass, yielding only a partial improvement in SA severity. These results suggest that SA should be systematically assessed before and after kidney Tx Support Swiss Kidney Foundation, the Pulmonary League and the Organ Transplant Foundation of Lausanne

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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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Strohmaier, Susanne, Christine Wallisch, Michael Kammer, Angelika Geroldinger, Georg Heinze, Rainer Oberbauer, and Maria C. Haller. "Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure." JAMA Network Open 5, no. 10 (October 7, 2022): e2234971. http://dx.doi.org/10.1001/jamanetworkopen.2022.34971.

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ImportanceKidney transplant is considered beneficial in terms of survival compared with continued dialysis for patients with kidney failure. However, randomized clinical trials are infeasible, and available evidence from cohort studies is at high risk of bias.ObjectiveTo compare restricted mean survival times (RMSTs) between patients who underwent transplant and patients continuing dialysis across transplant candidate ages and depending on waiting time, applying target trial emulation methods.Design, Setting, and ParticipantsIn this retrospective cohort study, patients aged 18 years or older appearing on the wait list for their first single-organ deceased donor kidney transplant between January 1, 2000, and December 31, 2018, in Austria were evaluated. Available data were obtained from the Austrian Dialysis and Transplant Registry and Eurotransplant and included repeated updates on wait-listing status and relevant covariates. Data were analyzed between August 1, 2019, and December 23, 2021.ExposuresA target trial was emulated in which patients were randomized to either receive the transplant immediately (treatment group) or to continue dialysis and never receive a transplant (control group) at each time an organ became available.Main Outcomes and MeasuresThe primary outcome was time from transplant allocation to death. Effect sizes in terms of RMSTs were obtained using a sequential Cox approach.ResultsAmong the 4445 included patients (2974 men [66.9%]; mean [SD] age, 52.2 [13.2] years), transplant was associated with increased survival time across all considered ages compared with continuing dialysis and remaining on the wait list within a 10-year follow-up. The estimated RMST differences were 0.57 years (95% CI, –0.14 to 1.84 years) at age 20 years, 3.01 years (95% CI, 2.50 to 3.54 years) at age 60 years, and 2.48 years (95% CI, 1.88 to 3.04 years) at age 70 years. The survival benefit for patients who underwent transplant across ages was independent of waiting time.Conclusions and RelevanceThe findings of this study suggest that kidney transplant prolongs the survival time of persons with kidney failure across all candidate ages and waiting times.

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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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Togninalli, Matteo, Daisuke Yoneoka, Antonios G. A. Kolios, Karsten Borgwardt, and Jakob Nilsson. "Pretransplant Kinetics of Anti-HLA Antibodies in Patients on the Waiting List for Kidney Transplantation." Journal of the American Society of Nephrology 30, no. 11 (October 25, 2019): 2262–74. http://dx.doi.org/10.1681/asn.2019060594.

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BackgroundPatients on organ transplant waiting lists are evaluated for preexisting alloimmunity to minimize episodes of acute and chronic rejection by regularly monitoring for changes in alloimmune status. There are few studies on how alloimmunity changes over time in patients on kidney allograft waiting lists, and an apparent lack of research-based evidence supporting currently used monitoring intervals.MethodsTo investigate the dynamics of alloimmune responses directed at HLA antigens, we retrospectively evaluated data on anti-HLA antibodies measured by the single-antigen bead assay from 627 waitlisted patients who subsequently received a kidney transplant at University Hospital Zurich, Switzerland, between 2008 and 2017. Our analysis focused on a filtered dataset comprising 467 patients who had at least two assay measurements.ResultsWithin the filtered dataset, we analyzed potential changes in mean fluorescence intensity values (reflecting bound anti-HLA antibodies) between consecutive measurements for individual patients in relation to the time interval between measurements. Using multiple approaches, we found no correlation between these two factors. However, when we stratified the dataset on the basis of documented previous immunizing events (transplant, pregnancy, or transfusion), we found significant differences in the magnitude of change in alloimmune status, especially among patients with a previous transplant versus patients without such a history. Further efforts to cluster patients according to statistical properties related to alloimmune status kinetics were unsuccessful, indicating considerable complexity in individual variability.ConclusionsAlloimmune kinetics in patients on a kidney transplant waiting list do not appear to be related to the interval between measurements, but are instead associated with alloimmunization history. This suggests that an individualized strategy for alloimmune status monitoring may be preferable to currently used intervals.

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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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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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Wong, G., K. Howard, J. R. Chapman, N. B. Cross, S. Chadban, A. Webster, and J. C. Craig. "LIFE YEARS GAIN AND COST-SAVINGS ON THE KIDNEY TRANSPLANT WAITING LIST." Transplantation Journal 90 (July 2010): 972. http://dx.doi.org/10.1097/00007890-201007272-01908.

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Kyllonen, Lauri, and Kaija Salmela. "Why do some diabetic patients on the kidney transplant waiting list not receive a transplant?" Transplant International 17, no. 9 (October 2004): 511–17. http://dx.doi.org/10.1111/j.1432-2277.2004.tb00480.x.

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Kyll�nen, Lauri, and Kaija Salmela. "Why do some diabetic patients on the kidney transplant waiting list not receive a transplant?" Transplant International 17, no. 9 (August 28, 2004): 511–17. http://dx.doi.org/10.1007/s00147-004-0754-z.

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Ajaimy, Maria, Luz Liriano-Ward, Jay A. Graham, and Enver Akalin. "Risks and Benefits of Kidney Transplantation during the COVID-19 Pandemic: Transplant or Not Transplant?" Kidney360 2, no. 7 (May 13, 2021): 1179–87. http://dx.doi.org/10.34067/kid.0002532021.

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AbstractCOVID-19 has significantly affected the transplant community, by leading to decreased transplant activity and increased waiting list time. As expected, COVID-19 causes substantial mortality in both ESKD and kidney transplant populations. This is due to underlying CKD and a high prevalence of comorbid conditions, such as diabetes mellitus, hypertension, and cardiovascular disease in this group. Transplant programs have faced the difficult decision of weighing the risks and benefits of transplantation during the pandemic. On one hand, there is a risk of COVID-19 exposure leading to infection while patients are on maximum immunosuppression. Alternatively, there are risks of delaying transplantation, which will increase waitlist times and may lead to waitlist-associated morbidity and mortality. Cautious and thoughtful selection of both the recipient’s and donor’s post-transplant management has been required during the pandemic, to mitigate the risk of morbidity and mortality associated with COVID-19. In this review article, we aimed to discuss previous publications related to clinical outcomes of COVID-19 disease in kidney transplant recipients, patients with ESKD on dialysis, or on the transplant waiting list, and the precautions transplant centers should take in decision making for recipient and donor selection and immunosuppressive management during the pandemic. Nevertheless, transplantation in this milieu does seem to be the correct decision, with careful patient and donor selection and safeguard protocols for infection prevention. Each center should conduct risk assessment on the basis of the patient’s age and medical comorbidities, waitlist time, degree of sensitization, cold ischemia time, status of vaccination, and severity of pandemic in their region.

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Muller, Elmi, and Zunaid Barday. "HIV-Positive Kidney Donor Selection for HIV-Positive Transplant Recipients." Journal of the American Society of Nephrology 29, no. 4 (January 12, 2018): 1090–95. http://dx.doi.org/10.1681/asn.2017080853.

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The risks associated with transplanting HIV-positive kidneys into HIV-positive recipients have not been well studied. Since 2008, 43 kidneys from 25 HIV-positive deceased donors have been transplanted into patients who are HIV positive in Cape Town, South Africa. Among the donors, 19 (76%) died secondary to trauma. The average age for donors was 34 (interquartile range, 19–52) years old. In some donors, only one kidney was used because of a limited number of suitable recipients on the waiting list. Only two donors had been previously exposed to antiretroviral triple therapy. In 23 of the deceased organ donors, the HIV status was not known before the time of death. Initial concerns about transplanting HIV-positive allografts into HIV-positive recipients in this clinic revolved around the possibility of HIV superinfection. However, all recipients remained virally suppressed several years after the transplant. Only one recipient experienced an increased viral load after the transplant, which was related to a period of noncompliance on her medication. After counseling and improved compliance, the viral load decreased and became suppressed again. Herein, we discuss the findings of this study and review the literature available on this crucial topic.

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Trivedi, Jaimin R., Mickey Ising, Matthew P. Fox, Robert M. Cannon, Victor H. Van Berkel, and Mark S. Slaughter. "Solid-Organ Transplantation and the Affordable Care Act: Accessibility and Outcomes." American Surgeon 84, no. 12 (December 2018): 1894–99. http://dx.doi.org/10.1177/000313481808401234.

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The objective of the study is to evaluate the impact of the Affordable Care Act (ACA) on accessibility to solid organ transplant and outcomes. Data source registry: United Network of Organ Sharing database. Patients aged ≥18 years listed for kidney, liver, heart, and lung transplant between years 2010 and 2016 were classified by insurance and status of Medicaid adoption under ACA to evaluate insurance distribution. Between 2010 and 2016, states that adopted Medicaid had 2 to 4 per cent point increase in the proportion of patients listed with Medicaid across all organs. One-year waiting list survival of Medicaid patients was better in the ACA era. States that expanded Medicaid under the ACA had a significant increase in the proportion of patients listed with Medicaid and better one-year waiting list survival.

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Toapanta, Néstor, Irina B. Torres, Joana Sellarés, Betty Chamoun, Daniel Serón, and Francesc Moreso. "Kidney transplantation and COVID-19 renal and patient prognosis." Clinical Kidney Journal 14, Supplement_1 (March 1, 2021): i21—i29. http://dx.doi.org/10.1093/ckj/sfab030.

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Abstract Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.

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Dedic, Gordana, Nenad Milojkovic, Zoran Cukic, and Dubravko Bokonjic. "Quality of life of hemodialysis patients waiting for kidney transplant." Vojnosanitetski pregled 74, no. 8 (2017): 749–56. http://dx.doi.org/10.2298/vsp150918259d.

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Background/Aim. Dialysis and kidney transplantation are treatments that can be applied to patients with the end-stage renal disease. There is a lack of information on the quality of life (QOL) among hemodialysis (HD) patients on the waiting list for a kidney transplant, a group that is increasing all over the world. The aim of this study was to investigate the quality of life of patients on HD waiting for a kidney transplant. Methods. In the clinical comparative 12-month study, QOL level was compared between consecutively recruited patients waiting for a kidney transplant (WT patients) (N = 24) and patients not waiting for a kidney transplant (non-WT patients) (N = 52). All patients were older than 18 years and were on HD at least three months. To measure QOL, the short Form Health Survey (SD-36) was used. Results. WT patients were younger (43.50 ? 12.64 vs 63.58 ? 13.88 years; p < 0.001), they had started dialysis in the younger age (32.38 ? 14.50 vs 57.12 ? 15.79 years; p < 0.001) and spent more time on dialysis (112.04 ? 82.48 vs 72.40 ? 81.31 months; p < 0.05) than non-WT patients. Non-WT patients had more comorbidities than WT patients (p < 0.01). In laboratory parameters, there were statistically significant differences in values of serum creatinine (p < 0.01), phosphorus (p < 0.05) and number used to quantyfy hemodialysis treatment adequacy (Kt/V index: K ? dialyzer clearance of urea; t ? dialysis time; V ? volume of distribution of urea approx equal to patients? total body water) (p < 0.05). Mean scores were higher among WT patients compared to non-WT patients in four dimensions of QOL: Physical Function (PF) (83.33 ? 10.59 vs 66.53 ? 27.87; respectively p > 0.05), Role Physical (RP) (58.66 ? 21.39 vs 46.90 ? 23.73; respectively p > 0.05), General health (GH) (45.00 ? 14.81 vs 37.98 ? 12.88; respectively p > 0.05); Social Functioning (SF) (93.66 ? 16.10 vs 78.30 ? 29.80; respectively p > 0.05) including Physical Component Summary (PCS) scores (64.16 ? 13.77 vs 52.38 ? 19.53; respectively p > 0.05). Conclusion. Patients waiting for a kidney transplant were younger, had started dialysis in the younger age and spent longer on dialysis compared with patients not eligible for transplantation. Low comorbidity, better laboratory parameters interferes in all domains with higher values of QOL in patients waiting for a kidney transplant, especially in general health, physical conditions and social functioning.

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Albán Tigre, Jorge, Andrea Villarreal Juris, Juan Mora Betancourt, and Víctor Betancourt Nole. "TRASPLANTE RENAL EN ECUADOR, PUNTOS CLAVE Y SITUACIÓN ACTUAL." Revista Medica Vozandes 31, no. 2 (January 6, 2021): 42–48. http://dx.doi.org/10.48018/rmv.v31.i2.6.

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IntroductionKidney transplantation in Ecuador began in 1976, it was limited until 2011, when the Organic Law of Donation and Transplantation of Organs, Tissues and Cells became valid. This is indicated in end-stage renal failure, in adult and pediatric patients; and, compared to peritoneal and renal dialysis, it is less expensive for the health system. In 2015, in Ecuador, at least 30,000 people suffered from end-stage kidney disease; 45% of them could die without treatment. The objective of this study was to determine the current situation in Ecuador regarding kidney transplantation. MethodologyA descriptive, retrospective study. INDOT statistics were reviewed from 2007 to August 2019, to determine the total number of transplants and kidney transplants, type of transplant, effective donors, rate of donors per million population (pmp), transplanted organ rate (pmp), evolution of the national waiting list, survival rate, etc. Results From 2007 to 2019, 6134 transplants were performed: 25.4% renal. Most donors were male (68.1%). The donor rate (pmp) between 2009 and 2019 was 4.2 (SD: ± 2.1). The mean rate of transplanted organs was 8.1 (SD: ± 3.6) (pmp) from 2007 to 2019. In this period 1560 kidney transplants were performed: 83.1% with cadaveric donors (88.1% adults; 11.9% pediatric) and 16.9% with living donors (72.4% adults; 27.6% pediatric). The one-year survival rate after cadaveric and living donor kidney transplantation was 0.94 and 0.97 in adults; and 0.90 and 0.97 in pediatrics, respectively. Currently there are only 5 accredited centers for kidney transplantation in adults and one for pediatric kidney transplantation .ConclusionsKidney transplantation has made significant progress in Ecuador, however, it is still below the World Health Organization (WHO) goal established for the proper management of patients with chronic kidney failure.

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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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Gharibi, Zahra, and Michael Hahsler. "A Simulation-Based Optimization Model to Study the Impact of Multiple-Region Listing and Information Sharing on Kidney Transplant Outcomes." International Journal of Environmental Research and Public Health 18, no. 3 (January 20, 2021): 873. http://dx.doi.org/10.3390/ijerph18030873.

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More than 8000 patients on the waiting list for kidney transplantation die or become ineligible to receive transplants due to health deterioration. At the same time, more than 4000 recovered kidneys from deceased donors are discarded each year in the United States. This paper develops a simulation-based optimization model that considers several crucial factors for a kidney transplantation to improve kidney utilization. Unlike most proposed models, the presented optimization model incorporates details of the offering process, the deterioration of patient health and kidney quality over time, the correlation between patients’ health and acceptance decisions, and the probability of kidney acceptance. We estimate model parameters using data obtained from the United Network of Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipients (SRTR). Using these parameters, we illustrate the power of the simulation-based optimization model using two related applications. The former explores the effects of encouraging patients to pursue multiple-region waitlisting on post-transplant outcomes. Here, a simulation-based optimization model lets the patient select the best regions to be waitlisted in, given their demand-to-supply ratios. The second application focuses on a system-level aspect of transplantation, namely the contribution of information sharing on improving kidney discard rates and social welfare. We investigate the effects of using modern information technology to accelerate finding a matching patient to an available donor organ on waitlist mortality, kidney discard, and transplant rates. We show that modern information technology support currently developed by the United Network for Organ Sharing (UNOS) is essential and can significantly improve kidney utilization.

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Wainright, Jennifer L., David K. Klassen, Anna Y. Kucheryavaya, and Darren E. Stewart. "Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List." Clinical Journal of the American Society of Nephrology 11, no. 11 (September 2, 2016): 2047–52. http://dx.doi.org/10.2215/cjn.01360216.

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Zhang, Yi, Mae Thamer, Onkar Kshirsagar, Dennis J. Cotter, and Mark J. Schlesinger. "Dialysis Chains and Placement on the Waiting List for a Cadaveric Kidney Transplant." Transplantation 98, no. 5 (September 2014): 543–51. http://dx.doi.org/10.1097/tp.0000000000000106.

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Journal articles on the topic 'Kidney transplant waiting list'

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