Background
A significant number of potential kidney transplant candidates do not complete the required medical evaluation after referral to a transplant program.
Methods
Factors associated with rate of completion of the renal transplant evaluation were analyzed using a retrospective chart review of patients first seen between October 1, 2009 and September 30, 2010 (n=256). The primary end point was completion in 12 months. Independent variables included socioeconomic, demographic, and medical factors.
Results
Mean age was 50.7 years; 49.6% were black, 28.5% Hispanic, and 21.9% white/other; 26.3% did not require dialysis. During follow-up, 23.4% did not complete the evaluation. Multivariable analysis indicated that slower rates of completion were associated with needing a greater number of medical tests (compared to 0–2: 3–5 tests, hazard ratio (HR)=0.65, p=0.02; ≥6 tests, HR=0.47, p=0.0005) and requiring >1 hospitalization (compared to none: HR=0.37, p=0.0008). A significant interaction between race/ethnicity and gender on completion was found: compared to black men, Hispanic men (HR=2.75, p<0.0001), Hispanic women (HR=1.96, p=0.006), and white men (HR=1.99, p=0.005) had more rapid completion. In comparison, black and white women (HR=1.38, p=0.16; HR=0.94, p=0.83, respectively) were not significantly different from black men in rates of completion. Differences by race/ethnicity and gender were not confounded by socioeconomic variables or social support.
Conclusions
In order to lessen barriers and facilitate renal transplantation, black men and women, white women, and patients needing multiple medical tests and requiring several hospitalizations may benefit from additional assistance during the medical evaluation process.