Many kidney transplant candidates fail to reach the national waitlist

Nearly half of Americans with kidney failure who are referred for transplantation never begin the process required to be considered for a new organ, a new study shows, while less than a fifth actually complete the assessment and get on the waitlist.

Led by NYU Langone Health researchers, the national study of 720,348 patients referred for the procedure found that those who were unmarried, had severe obesity, or lived in rural areas were less likely to start or complete an evaluation at a transplant center and make the waitlist. Older, Spanish-speaking, and poorer patients were especially unlikely to progress, as were those treated at smaller centers or at programs in the South. Results showed that only 19 percent of referred patients completed the evaluation, and 48 percent never even started it.

Much of this variation may stem from the complexity of the process, which can be difficult for patients to navigate, said Dr. Donnelly. Once a referral for a kidney transplant is made, the patient undergoes a battery of tests to provide a detailed picture of their health. These tests may include blood work, chest imaging, and cancer screenings, often requiring the patient to make several visits over a period of months while also attending dialysis sessions each week. Only after this process is completed and the candidate is approved are they placed on the waitlist.

Smaller centers with fewer resources and transplant slots may be more selective and risk-averse than larger programs, the researchers said. Also, candidates who are unmarried or lack strong social support may struggle to make repeated trips for evaluations and follow-up appointments. This may help explain why people living in urban areas, where transplant centers are more numerous and often closer to home, are more likely to move forward in the process.

Publishing online June 20 in the Journal of the American Society of Nephrology, the study is the largest and most detailed to date to examine where patients drop out of the kidney transplant process, according to the authors. It is simultaneously being presented at the American Transplant Congress, the annual joint meeting of the American Society of Transplantation and the American Society of Transplant Surgeons.

"These results demonstrate that finding ways to reduce barriers to both evaluation and waitlisting could help expand much-needed access to kidney transplantation," said study co-senior author Allan B. Massie, PhD, an associate professor in the Departments of Surgery and Population Health at NYU Grossman School of Medicine. "Providing patients with better education and support to help them navigate the complex and sometimes grueling process would be a good start."

Source:

NYU Langone Health

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