Outcomes of a Wait-List Clinic to Monitor the Health of Dialysis Patients on the Waiting List for a Kidney Transplant at the Singapore General Hospital

Abstract

Introduction: The wait-list for a deceased donor kidney transplant (DDKTX) at the Singapore General Hospital (SGH) in 2011 was 347, representing 70 % of all patients waiting for a DDKTX in Singapore. Unfortunately, the waiting time to receive DDKTX remains long at 10 years and has no consensus on the management of wait-listed patients (WLP). In January 2011, the kidney transplant program started a Wait-List clinic (WLC) to provide standardized follow-up and monitor the health status of WLP. Methods: The WLC was held twice a month. During WLC, patients received detailed counseling and information about DDKTX. Patients were required to sign informed consent for DDKTX and acknowledgement form about their responsibilities on the wait-list. Following counseling, patients were reviewed by transplant nephrologist with a bi-yearly appointment scheduled. Results: Between January and December 2011, 27 % (n=94/347) of WLP were seen. 29 % (n=27/94) patients had their wait-list status changed where 6.4% (n=6/94), 14.9% (n=14/94), 6.4% (n=6/94) and 1.1% (n=1/94) were reactivated, suspended, de-registered (due to medical reasons) and opted-out from the wait-list respectively. 25% (n=14/57) of patients who have attended WLC were activated for DDKTX, representing 31% (n=8/26) of patients receiving DDKTX and 27% (n=6/22) of standbys. Notably, 87.2% (n=82/94) of patients seen at WLC had waited for ≥ 7 years which is comparable to the majority of patients (84.6%; n=22/26) who received a DDKTX in 2011. Despite prior review at WLC, there was no significant difference in the cold ischemia times (CIT) between WLC and non-WLC patients. Conclusion: Preliminary experience of WLC suggests that it is a useful service with 29 % of WLP experiencing a change in their wait-listed status and 25% of WLP subsequently being activated for DDKTX in 2011. However, the anticipated benefit of shorter CIT for WLP was not found, suggesting that there are other factors that influence CIT.