Study: More staff, communication needed after ‘graduating’ patients after transplantation
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Key takeaways:
- Stable kidney transplant patients are commonly “graduated” back to local nephrologist care.
- Transplant centers “can actively help” nephrologist concerns about lack of communication and resources.
PHILADELPHIA — Many kidney transplant patients successfully advance from transplant centers back to their local nephrologists, but providers find there is room for improvement in the transition, according to data presented at ASN Kidney Week.
“We found that graduation of kidney transplant patients is common, with half of transplant centers using a joint-care approach and another third reporting full return to the referring nephrologist, although timing of transitions varied. Staffing shortages and communication barriers pose challenges for long-term co-management,” Krista L. Lentine, MD, PhD, told Healio. “We believe this work highlights the need for more resources to support the transplant nephrology workforce along with education in posttransplant care competencies for referring providers to enable appropriate care of the growing population of transplant recipients.”
To get a sense for how these transitions in care back to referring nephrologists are being performed, Lentine and colleagues surveyed 108 staff at U.S. adult kidney transplant centers between April 5, 2022, and Oct. 31, 2022, as well as 105 general nephrologists during October 2022.
General nephrologists mostly reported post-graduation visits as occurring every 3 months (51%), with more frequent lab draws (monthly: 32%; every 3 months: 33%). The most cited reason for referral back to a transplant center was allograft dysfunction (79%), followed by cancer (51%), pregnancy planning (41%) and fever (21%). Fifteen practices noted that it did not accept graduated patients, with most noting the practice could not work closely with the transplant center or were not equipped for immunosuppression monitoring.
In the survey of transplant centers, 48% reported only partial graduation with ongoing co-management, while 37% reported full graduation. These centers reported rationales for graduation including patient travel distance (64%), maintenance of referral base (58%), continuity of care (58%) and transplant center burden (54%). Seventy percent of transplant centers said more clinicians are needed, and nearly half said more physical space or telehealth is necessary.
Transplant centers highlighted the following reasons for post-graduation return of care: worsening renal function (80%); malignancy (66%); opportunistic infection (63%); local nephrologist availability (58%); and pregnancy planning (57%).
Lentine and colleagues concluded general nephrologist concerns about communication and lack of office resources are problems that transplant centers “can actively help” alleviate, adding that “expanded opportunities related to transplant care for the general nephrologist community are essential.”
Reference:
Lentine KL, et al. TH-PO849. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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Lentine KL, et al. TH-PO849. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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