Kidney Transplantation in Individuals Living in Long-Term Care Settings: A National Survey of Professionals On Best Practices.

Abstract

Purpose: With advances in medical treatments for many chronic illnesses and older potential kidney transplant (KT) recipients with end stage renal disease (ESRD), KT centers are now receiving a greater number of referrals for individuals with ESRD who live in long-term care (LTC) settings. To build the literature related to KT in LTC residents, we conducted a national online survey of KT professionals (KTP) to assess best practices in this area. Methods: 126 KTP, including social workers, nephrologists and surgeons completed an online survey in 2013. Descriptive statistics were calculated using SPSS software. Results: Almost 50% of the survey respondents reported that their transplant center had offered a KT to LTC residents, 27% had not, and 27% did not know if they had. The following reasons were given for not approving a LTC resident for a KT: risk of infection (43%); poor use of a scarce resource (34%); likelihood of medical co-morbidities (66%); and no improvement in patient quality of life (69%). In the survey, KTP were given hypothetical patient scenarios to assess the KT candidacy of LTC residents with various reasons for LTC residency (e.g. dementia). Results summarized below.Table: No Caption available.A strong majority of respondents (74%) reported that they would not offer KT to a LTC resident with mild dementia. Conclusions: To our knowledge, this is the first survey of KTP related to transplantation of LTC residents. The results of this survey suggest that there is currently no best practice consensus among KT centers related to providing KT to LTC residents. The majority of centers appeared reluctant to offer KT to LTC residents with dementia. Lack of improvement in quality of life appeared to be the leading concern for not offering KT to LTC residents. Further research specifically focusing on outcomes of KT in residents of LTC might help KTP provide better services to LTC residents.