Access to kidney transplantation: outcomes of the non-referred

Meteb M Albugami,Romuald Panek,Karthik Tennankore,Bryce A Kiberd,Steven Soroka

doi:10.1186/2047-1440-1-22

Abstract

BackgroundThere is a concern that some, especially older people, are not referred and could benefit from transplantation.MethodsWe retrospectively examined consecutive incident end stage renal disease (ESRD) patients at our center from January 2006 to December 2009. At ESRD start, patients were classified into those with or without contraindications using Canadian eligibility criteria. Based on referral for transplantation, patients were grouped as CANDIDATE (no contraindication and referred), NEITHER (no contraindication and not referred) and CONTRAINDICATION. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden.ResultsOf the 437 patients, 133 (30.4%) were CANDIDATE (mean age 50 and CCI 3.0), 59 (13.5%) were NEITHER (age 76 and CCI 4.4), and 245 (56.1%) were CONTRAINDICATION (age 65 and CCI 5.5). Age was the best discriminator between NEITHER and CANDIDATES (c-statistic 0.96, P <0.0001) with CCI being less discriminative (0.692, P <0.001). CANDIDATES had excellent survival whereas those patients designated NEITHER and CONTRAINDICATION had high mortality rates. NEITHER patients died or developed a contraindication at very high rates. By 1.5 years 50% of the NEITHER patients were no longer eligible for a transplant.ConclusionsThere exists a relatively small population of incident patients not referred who have no contraindications. These are older patients with significant comorbidity who have a small window of opportunity for kidney transplantation.

Highlights

There is a concern that some, especially older people, are not referred and could benefit from transplantation
In a small prospective study we found that nearly 25% of incident End Stage Renal Disease (ESRD) patients had no contraindications to transplantation using published Canadian consensus recommendations and were not referred
This study shows that there exists a small subset (

Summary

Introduction

There is a concern that some, especially older people, are not referred and could benefit from transplantation. One of the most important tasks of a nephrologist is to evaluate and refer patients with End Stage Renal Disease (ESRD) for a kidney transplant. Some have argued that many older patients are not being transplanted because of ‘ageism’ [2,3]. In a small prospective study we found that nearly 25% of incident ESRD patients had no contraindications to transplantation using published Canadian consensus recommendations and were not referred. The single most important discriminating factor was age [4]. In those without contraindications to kidney transplantation, patients referred

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Results

Discussion

Conclusion