Barriers to Preemptive Renal Transplantation
- 1 March 2015
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Transplantation
- Vol. 99 (3), 576-579
- https://doi.org/10.1097/tp.0000000000000357
Abstract
Preemptive transplantation results in excellent patient and graft survival yet most transplant candidates are referred for transplantation after initiation of dialysis. The goal of this study was to determine barriers to preemptive renal transplantation. A nonvalidated questionnaire was administered to prospective kidney transplant recipients to determine factors that hindered or favored referral for transplantation before the initiation of dialysis. One hundred ninety-seven subjects referred for a primary renal transplant completed the questionnaire. Ninety-one subjects (46%) had been informed of preemptive transplantation before referral, and 80 (41%) were predialysis at the time of evaluation. The median time from diagnosis of renal disease to referral was 60 months (range, 2-444 months). In bivariate analysis, among other factors, knowledge of preemptive transplantation was highly associated (odds ratio=94.69) with referral before initiation of dialysis. Given the strong association between knowledge of preemptive transplantation and predialysis referral, this variable was not included in the multivariate analysis. Using multivariate logistic regression analysis, white recipient race, referral by a transplant nephrologist, recipient employment, and the diagnosis of polycystic kidney disease were significantly associated with presentation to the pretransplant clinic before initiation of dialysis. The principle barrier to renal transplantation referral before dialysis was patient education regarding the option of preemptive transplantation. Factors significantly associated with referral before dialysis were the diagnosis of polycystic kidney disease, white recipient race, referral by a transplant nephrologist, and employed status. Greater effort should be applied to patient education regarding preemptive transplantation early after the diagnosis of end-stage renal disease.Keywords
This publication has 9 references indexed in Scilit:
- Preemptive Deceased Donor Kidney TransplantationClinical Journal of the American Society of Nephrology, 2013
- Disparities in Provision of Transplant Education by Profit Status of the Dialysis CenterAmerican Journal of Transplantation, 2012
- A Survey of Nephrologists’ Views on Preemptive TransplantationClinical Journal of the American Society of Nephrology, 2008
- Insurance Type and Minority Status Associated with Large Disparities in Prelisting Dialysis among Candidates for Kidney TransplantationClinical Journal of the American Society of Nephrology, 2008
- A comparison of persons who present for preemptive and nonpreemptive kidney transplantationAmerican Journal of Kidney Diseases, 2003
- Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomesTransplantation, 2002
- Preemptive Kidney TransplantationJournal of the American Society of Nephrology, 2002
- Effect of the Use or Nonuse of Long-Term Dialysis on the Subsequent Survival of Renal Transplants from Living DonorsNew England Journal of Medicine, 2001
- Effect of waiting time on renal transplant outcomeKidney International, 2000