Abstract
BackgroundIncreased morbidity and mortality are well documented in Status 7(inactive list) patients. Delays in transplantation secondary to prolonged periods on inactive status also negatively impacts transplant outcomes. We developed an effective system to reduce the proportion of status 7 patients on our kidney transplant waitlist. This can easily be reproduced by other transplant centers since concerns about Status 7 list size are commonplace.MethodsMeetings of a dedicated status 7 focus group were undertaken biweekly beginning in April 2016, each lasting for 1 hour or less. The group was led by a transplant physician and comprised of members from all disciplines of the kidney transplant department. Individual patient barriers to activation were systematically evaluated and action plans were developed to overcome those. The formal meetings were supplemented by updates to an electronic database accessible to all members of the team.ResultsIn the first 2 years of the program, we were able to activate and eventually transplant 18% of the formerly inactive patients. Forty percent of all inactive patients were removed from the waitlist due to one or more unsurmountable barriers. The median time patients stayed inactive on the waitlist was shortened from 1344 days at the start of this initiative to 581 days at the end.ConclusionThis strategy of systematic reevaluation of status 7 patients resulted in successful disposition of a substantial number of inactive patients. Further, waitlist time was reduced and transplantation expedited for the appropriate individuals. This approach could easily be adapted by other transplant centers with minimum utilization of resources.
Highlights
Increased morbidity and mortality are well documented in Status 7(inactive list) patients
Longer wait time on the kidney transplant waitlist is independently associated with adverse outcomes before and after transplantation, especially for the dialysis dependent patients [1]
In order to reduce the proportion of status 7 patients on our transplant waitlist, we developed a system to re-evaluate such patients
Summary
Increased morbidity and mortality are well documented in Status 7(inactive list) patients. We developed an effective system to reduce the proportion of status 7 patients on our kidney transplant waitlist. This can be reproduced by other transplant centers since concerns about Status 7 list size are commonplace. Longer wait time on the kidney transplant waitlist is independently associated with adverse outcomes before and after transplantation, especially for the dialysis dependent patients [1]. By the end of 2016, 30% of nearly 100,000 patients listed for kidney transplantation in the United States were inactive at any given time [4]. Of the 30,000 new patient registrants on the kidney transplant waitlist in the same year, almost one third were initially inactive [4] (status 7). Referral for transplantation alone is not sufficient to improve access to transplant [5] and many patients spend almost over half of their wait time inactive
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