Factors Associated with Completion of Pre–Kidney Transplant Evaluations

Abstract

This study sought to examine various factors that may prevent transplant candidates from completing their transplant workup prior to listing. We reviewed the records of 170 subjects (cases = 100, controls 70) who were either on dialysis or had less than 20 mL/min creatinine clearance and were therefore candidates for preemptive transplantation. Approximately, 56% of preemptive patients completed their workup, while only 36% of patients on dialysis completed their workup. Our data revealed that factors contributing toward completion of workup included intrinsic motivation (four times more likely), lack of specific medical comorbidities (three times more likely), and preemptive status (two times more likely). Among patients on dialysis, intrinsic motivation (five times more likely) and absence of cardiovascular complications (four times more likely) were associated with completion. When comparing patients on dialysis to patients not on dialysis, there were significant differences between the two groups in distance from home to the transplant center, level of education, and presence of medical comorbidities. We believe that targeted interventions such as timely referral, providing appropriate educational resources, and development of adequate support systems, have the potential to improve workup compliance of patients with advanced chronic kidney disease, including those on dialysis.

Keywords

renal transplantation - dialysis status - compliance - nephrology - patient education

• References

• 1 Cetingok M, Winsett RP, Hathaway DK. A comparative study of quality of life among the age groups of kidney transplant recipients. Prog Transplant 2004; 14 (1) 33-38
• 2 Wolfe RA, Ashby VB, Milford EL , et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341 (23) 1725-1730
• 3 Humar A, Dunn D. Schwartz's Principles of Surgery. 9th ed. Transplantation. Columbus, OH: McGraw-Hill; 2010
• 4 Gill P, Lowes L. Gift exchange and organ donation: donor and recipient experiences of live related kidney transplantation. Int J Nurs Stud 2008; 45 (11) 1607-1617
• 5 Olbrisch ME, Benedict SM, Haller DL, Levenson JL. Psychosocial assessment of living organ donors: clinical and ethical considerations. Prog Transplant 2001; 11 (1) 40-49
• 6 Parker III TF, Straube BM, Nissenson A, Hakim RM, Steinman TI, Glassock RJ. Dialysis at a crossroads—Part II: A call for action. Clin J Am Soc Nephrol 2012; 7 (6) 1026-1032
• 7 Malho A, Malheiro J, Fonseca I , et al. Advantages of kidney transplant precocity in graft long-term survival. Transplant Proc 2012; 44 (8) 2344-2347
• 8 Huang Y, Samaniego M. Preemptive kidney transplantation: has it come of age?. Nephrol Ther 2012; 8 (6) 428-432
• 9 Weng FL, Joffe MM, Feldman HI, Mange KC. Rates of completion of the medical evaluation for renal transplantation. Am J Kidney Dis 2005; 46 (4) 734-745