POS-811 A RETROSPECTIVE STUDY TO ASSESS DROPOUT RATE AND ITS CAUSES IN LIVING DONOR TRANSPLANT PROGRAM IN INDIA

Abstract

Kidney transplant programs in developing countries rely heavily on living donor programs. Though increasing, deceased donor programs are still in infancy due to resource constraints and social or cultural barriers against deceased organ donation. As the burden of end-stage kidney disease (ESKD) is rising, the waiting times for transplants in living donor kidney transplant programs in public sector hospitals are increasing. A significant proportion of patients who do register with provisionally eligible living kidney donors ultimately do not receive transplants. Therefore, we decided to explore the reasons for dropout from the living donor kidney transplant program at a large public sector hospital in India. The study was done at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. At PGIMER, living kidney donors are provisionally registered in the program after ruling out kidney disease and its risk factors. Thereafter, the recipient-donor pairs are extensively evaluated. The priority is decided by the date of donor registration. Retrospectively, we looked at all the provisionally eligible recipient-donor pairs registered between 1stJanuary 2018 and 31stDecember 2019. Pairs who did not undergo a kidney transplant at our center were contacted and reasons for the same were noted. A total of 576 eligible recipient-donor pairs were registered between 2018 and 2019. 252 (43.8%) underwent a living donor kidney transplant at our center (figure 1). The median waiting period from the time of registration to the date of the transplant was 246 days (IQR 133 days). 130 (22.6%) pairs could not be reached despite repeated attempts. Out of the remaining 194 (33.7%), 33 underwent a kidney transplant with the same donor at a private center due to long delays at our center. In the remaining 161 pairs, reasons for not getting the transplant were as follows: 73 (12.7%) recipients died while they were waiting for the transplant, donors were detected to be medically or surgically unfit in 44 (7.6%) pairs at subsequent evaluation, 12 (2%) had a positive crossmatch and 15 (2.6%) recipients changed their mind and continued hemodialysis. Other reasons included poor finances, legal issues in approval of donor, and death of other kidney paired donation (KPD) recipients thereby leaving the first recipient without an eligible living donor. 56.2% of living kidney recipient-donor pairs dropped out of living donor kidney transplant program at a large public sector hospital in India. 22.5% could not be contacted while 5.7% went on to get the transplant at a private center. 12.7% died while waiting to get a slot for surgery. Despite the availability of living kidney donors, 36% (161/446) failed to get a transplant. It is likely that the outcomes would be at least similar in the group that could not be contacted. The data suggest an urgent need for upscaling living donor kidney transplant programs, laying the foundation for quality improvement (QI) initiatives to optimize resource utilization and hence, improve accessibility in living donor transplant programs.