Barriers to kidney transplantation in ESKD

Venkataraman, Sandheep; Kendrick, Jessica

doi:10.1111/sdi.12921

Cited by 13 publications

(17 citation statements)

References 97 publications

(277 reference statements)

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“…These findings are consistent with current waitlisting practices and previous studies that found that transplant providers were less likely to recommend patients for transplantation if they had comorbidities, had no social support, were non-adherent, and were older [29,30]. By contrast, experts did not identify race, ethnicity, socioeconomic status, or sex as important considerations in KT evaluation, despite waitlisting trends demonstrating lower access to KT among patients who are racial and ethnic minorities, women, or belong to a lower socioeconomic status [31][32][33][34][35][36]. It is important to note that even though providers did not explicitly list socioeconomic status as an important factor, social support and socioeconomic status are often related and thus decisions made during transplant evaluations could be unfavorable to patients of low socioeconomic status [30,37].…”

Section: Discussionmentioning

confidence: 84%

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts

et al. 2022

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Background Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function during transplant evaluation to help identify appropriate candidate. Yet, there are no ethical guidelines regarding the use of frailty and cognitive function during this evaluation. We seek to develop a clinical consensus on balancing utility and justice in access to KT for frail and cognitively impaired patients. Methods Twenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement). Results Experts believed that denying patients transplantation based solely on expected patient survival was inequitable to frail or cognitively impaired candidates; 100% agreed that frailty and cognitive impairment are important factors to consider during KT evaluation. There was consensus that health related quality of life and social support are important to consider before waitlisting frail or cognitively impaired patients. Experts identified important factors to consider before waitlisting frail (likely to benefit from KT, frailty reversibility, age, and medical contraindications) and cognitively impaired (degree of impairment and medication adherence) patients. Conclusions Clinical experts believed it was ethically unacceptable to allocate organs solely based on patients’ expected survival; frailty and cognitive impairment should be measured at evaluation when weighed against other clinical factors. Ethical guidelines regarding the use of frailty and cognitive function during KT evaluation ought to be developed.

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Section: Discussionmentioning

confidence: 84%

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts

et al. 2022

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“…Hispanics are the largest and fastest growing ethnic minority group in the United States [10]. Numerous studies have identified disparities and barriers to kidney transplantation [11]. Unfortunately, disparities exist in all components of the transplantation process.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, disparities exist in all components of the transplantation process. Patient-, physician/provider-and system-related barriers have all been identified [11]. Studies have found that medical eligibility (such as age and comorbidities) does not explain ethnic disparities in transplantation.…”

Section: Discussionmentioning

confidence: 99%

Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center

et al. 2022

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Introduction Hispanic Americans receive disproportionately fewer organ transplants than non-Hispanic whites. In 2018, the Hispanic Kidney Transplant Program (HKTP) was established as at the University of Colorado Hospital (UCH). The purpose of this quality improvement study was to examine the effect of this culturally sensitive program in reducing disparities in kidney transplantation. Methods We performed a mixed-methods analysis of data from 436 Spanish-speaking patients referred for transplant to UCH between 2015 and 2020. We compared outcomes for patients referred between 2015–2017 (n = 156) to those referred between 2018–2020 (n = 280). Semi-structured phone interviews were conducted with 6 patients per time period and with 6 nephrology providers in the Denver Metro Area. Patients and providers were asked to evaluate communication, transplant education, and overall experience. Results When comparing the two time periods, there was a significant increase in the percentage of patients being referred (79.5% increase, p-0.008) and evaluated for transplant (82.4% increase, p = 0.02) during 2018–2020. While the number of committee reviews and number waitlisted increased during 2018–2020, it did not reach statistical significance (82.9% increase, p = 0.37 and 79.5% increase, p = 0.75, respectively. During patient and provider interviews, we identified 4 themes reflecting participation in the HKTP: improved communication, enhanced patient education, improved experience and areas for advancement. Overall, patients and providers reported a positive experience with the HKTP and noted improved patient understanding of the transplantation process. Conclusions The establishment of the HKTP is associated with a significant increase in Spanish-speaking Hispanic patients being referred and evaluated for kidney transplantation.

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“…It is well-known that most patients who undergo kidney transplantation experience improvement in quality of life and improved survival when compared to patients who are waiting for kidney transplantation [ 2 ]. One of the major obstacles to kidney transplantation is the availability of a kidney donor, whether living or deceased [ 3 ]. The scarcity of such donations has led to an increasing number of patients waiting for a kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

A Three-Year Experience With Overseas Kidney Transplantation in a Tertiary Transplant Center in Saudi Arabia

Tawhari¹,

Radwi²

2022

Cureus

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Background Overseas kidney transplantation is known to be associated with adverse outcomes. In this study, we aim to present a detailed analysis of our three years of experience with overseas kidney transplantation at one of the largest kidney transplant referral sites in the Kingdom of Saudi Arabia. Materials and methods A retrospective cohort study included patients who underwent kidney transplantation overseas and were subsequently followed up at King Abdulaziz Medical City from January 2016 to July 31, 2019. In addition, we compared the outcomes of the patients who underwent kidney transplantation overseas with a cohort of patients who were transplanted locally within the same period. Patients in both cohorts had to have at least one year of follow-up post-transplantation. Results We included a total of 51 patients who underwent kidney transplantation overseas. The mean age of the cohort was 44.7 years, and 69% were male. Almost 60% of the cohort had one or no comorbidity prior to transplant, with hypertension (84%) and diabetes mellitus (37%) being the leading comorbidities. The cause of end-stage kidney disease was unknown in 55% of our patients. In those who had an identifiable cause, lupus nephropathy and diabetes were the most common causes of kidney failure. In comparison with the locally transplanted cohort, no difference was detected between these groups in their baseline characteristics, type or number of comorbidities, medical or surgical complications postoperatively, and one-year mortality. However, we found that the graft rejection rate was significantly higher in patients transplanted overseas (OR=5.4, p<0.001). In addition, the proportion of patients who received anti-thymocyte globulin (ATG) induction was also less in the group with overseas kidney transplantation (58% vs. 22%, p<0.001). Conclusion Overseas transplantation is associated with an increased risk for graft rejection. Our study suggests that overseas kidney transplantation is possibly driven by a lack of donors, especially cadaveric. Counseling patients about risks associated with overseas kidney transplantation and encouraging the public to register for organ donation after death may help curb out this practice.

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Barriers to kidney transplantation in ESKD

Cited by 13 publications

References 97 publications

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts

Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center

A Three-Year Experience With Overseas Kidney Transplantation in a Tertiary Transplant Center in Saudi Arabia

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