COMMENTARY

The Wait to Be Listed for a Kidney Affects Outcome

Ron Shapiro, MD

Disclosures

November 15, 2010

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Hi. My name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today I want to discuss a very interesting -- although somewhat complex -- paper looking at the relationship between waiting time and outcome after renal transplantation.[1] A number of studies have demonstrated that patients who are transplanted before they go on dialysis do better than patients with any degree of waiting time, and then every year of waiting time on the list is associated with worse outcomes.

This study parsed this issue further and pointed out that the big problem was with the time from development of end-stage renal disease to getting on the waiting list. The longer the patients spent during this process, the worse their outcomes were, the higher the mortality, and the worse the graft survival. Once patients were on the waiting list, there did not seem to be a problem with increased waiting time in terms of graft survival, although there was an effect on mortality of being on the waiting list.

Further studies suggest that insurance and race are important determinants of the amount of time it takes to get on a waiting list. This analysis is really quite interesting and suggests that we need to redouble our efforts to try to evaluate patients before they go on dialysis, with the goal of getting them wait-listed and hopefully transplanted before the need for dialysis. Thank you very much.

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