High-Priority Patients Often Don't Make It to the Kidney Transplant Wait List

By Reuters Staff

June 18, 2021

NEW YORK (Reuters Health) - Kidney transplantation is often the best option for people with end-stage kidney disease (ESKD), but many "high priority" patients are not placed on the kidney-transplant wait list, new research suggests.

Currently, the national kidney allocation system uses an estimated post-transplant survival (EPTS) score to identify candidates with the longest expected post-transplant survival and preferentially allocates the highest-quality donor kidneys to these patients.

With this system, younger candidates without diabetes or other medical issues who have not had a prior transplant and with little or no time on maintenance dialysis have lower EPTS scores. Candidates with EPTS score of 20% or lower - "top-20% EPTS status" - have preferential access to donor kidneys before other candidates. A person's EPTS score is dynamic and changes over time such that patients will eventually lose their top-20% status.

To examine the extent to which ESRD patients with top-20% EPTS status are placed on the transplant waiting list, Dr. Jesse Schold and colleagues at Ohio's Cleveland Clinic examined data from the U.S. Renal Data System on all U.S. adults who were waitlisted before starting dialysis (preemptive listing) or who initiated dialysis between 2015 and 2017.

Among the 42,445 adults with top-20% EPTS status, 7,922 were preemptively waitlisted, while 34,523 started dialysis, the team reports in the Journal of the American Society of Nephrology.

According to the researchers, fewer than half of eligible adults with top-20% EPTS scores were placed on the kidney transplant waiting list. Specifically, only 37% of those who initiated dialysis with top 20% EPTS status were waitlisted within three years.

African Americans, people without commercial health insurance, and residents of low-income neighborhoods were less likely to be waitlisted.

Among adults starting dialysis, 61% lost their top-20% EPTS status within 30 months, compared with 18% of preemptively listed adults.

Deceased- and living-donor transplantation rates within three years were 5% and 6%, respectively, for patients who initiated dialysis, compared with 26% and 44% for preemptively listed patients.

"The results indicate that there are numerous patients with kidney failure who would qualify for top 20% status but are not placed on the waiting list," Dr. Schold said in a news release.

"This is important given the high likelihood that these patients would benefit from transplantation and that they will lose top 20% status in the future. As such, expedited placement on the waiting list for these patients is critically important," he added.

It will also be important to address the racial and socioeconomic disparities revealed by this study, he said. "These results are important to emphasize the need to develop more effective education, interventions, and policies to expedite access to transplantation for patients who would benefit and to attenuate longstanding disparities in these processes of care," Dr. Schold said.

SOURCE: https://bit.ly/3vDuElA Journal of the American Society of Nephrology (JASN), online June 17, 2021.

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