Transplant Professionals’ Perceptions of Long-Term Care Residents’ Candidacy for Kidney Transplantation

Abstract

This survey of a large number of KTx professionals suggests that there is presently no best practice consensus regarding offering KTx to patients living in LTC settings. Further research should include a broader range of KTx professionals and should also include a study of outcomes with KTx in this particular patient population.

Kidney Transplantation Contraindications: Variation in Nephrologist Practice and Training Vintage

“…Moreover, the variation we observed may contribute to observed geographic and racial or ethnic disparities in access to kidney transplantation and downstream outcomes, 37 , 38 including where these disparities persist after controlling for patients’ comorbid conditions, including known contraindications to transplant. 39 Variation in local transplant center criteria and in clinical practice guidelines themselves 40 , 41 , 42 , 43 will also contribute to geographic variation in kidney transplant access, both independently and through their influence on the referral behaviors of nephrologists and their care teams. Notably, because our survey focuses on the earliest step on the pathway to transplant—the nephrologist’s prereferral assessment of the patient’s suitability for transplant—it may be that factors at work in other downstream steps (e.g., transplant center evaluation) could accentuate or mitigate associations between the referring nephrologists’ application of evaluation criteria and downstream patient waitlisting and transplant receipt outcomes.…”

Cardiologist Evaluation and Approval Was the Primary Predictor of Kidney Transplant Candidacy and Transplantation Among Patients With Reduced Left Ventricular Ejection Fraction

“…Although attempts have been made to standardize the kidney transplant evaluation with measures such as proposed prognostic indicators, expert guidelines‚ and multidisciplinary involvement on transplant committee teams, subjective input continues to play a role. There are several published qualitative studies that examine a nephrologist's perceptions and practices regarding transplant candidacy, [16][17][18] but quantitative data are sparse. Lenihan et al 19 used multivariate logistic regression to explore factors associated with waitlisting for transplant specifically in the elderly population and found that older age, coronary artery disease, and poor mobility adversely affected listing.…”