Timing of the pre-transplant workup for renal transplantation: is there room for improvement?

Abstract

Background Since patient survival after kidney transplantation is significantly improved with a shorter time on dialysis, it is recommended to start the transplant workup in a timely fashion. Methods This retrospective study analyses the chronology of actions taken during the care for patients with CKD stage 5 who were waitlisted for a first kidney transplant at the Antwerp University Hospital between 2016 and 2019. We aimed to identify risk factors for a delayed start of the transplant workup (i.e. after dialysis initiation) and factors that prolong its duration. Results Of the 161 patients included, only 43% started the transplant workup before starting dialysis. We identified the number of hospitalization days (OR 0.79, 95%CI: 0.69-0.89, p < 0.001), language barriers (OR 0.20, 95%CI: 0.06-0.61, p = 0.005) and a shorter nephrology follow-up before CKD stage 5 (OR 0.99, 95%CI: 1.0-0.98, p = 0.034) as factors having a significant negative impact on the probability of starting the transplant screening before dialysis. The workup took a median of 8.6 months (IQR 5-14) to complete. The number of hospitalization days significantly prolonged its duration. Conclusion The transplant workup was often started too late and the time needed to complete it was surprisingly long. By starting the transplant workup in a timely fashion and reducing the time spent on the screening examinations, we should be able to register patients on the waiting list before or at least at the start of dialysis. We believe that such an internal audit could be of value for every transplant center.

Development of a checklist framework for kidney transplantation

“…The recently updated Kidney Disease: Improving Global Outcomes guidelines ( 12 ) recommended the referral of potential kidney transplant candidates for evaluation at least 6–12 months before anticipated dialysis initiation in order to facilitate the identification and workup of living donors and to plan for possible pre-emptive transplantation. The reason is that the time spent on dialysis before transplantation appears to have a directly proportional negative effect on patient and/or graft survival ( 13 ). Symptomatic hypotension is a common complication in patients with end-stage renal disease ( 14 ).…”