Start time varies in kidney transplant evaluation
Key takeaways:
- Overall, 51% of patients referred from dialysis to transplant centers began evaluation within 6 months.
- Median odds ratio for variation between transplant centers was higher than that for dialysis facilities.
There is no standard approach to starting kidney transplant evaluations in patients referred from dialysis facilities to transplant centers, according to a retrospective analysis.
“A majority of patients with kidney failure begin treatment at a dialysis facility, with 84% starting in-center hemodialysis in 2020,” Laura McPherson, PhD, of the Emory University Rollins School of Public Health Department of Epidemiology in Atlanta, wrote with colleagues. “While dialysis facilities and transplant centers are known to jointly influence access to transplantation, their relative contributions to starting the evaluation process has not been examined simultaneously. It remains unclear whether these health care entities are equally important or if one plays a more significant role than the other.”
The cohort analysis identified 25,488 patients at 1,720 dialysis facilities and 26 transplant centers in the Southeast and Northeast of the United States, and the New York and Ohio River Valley regions from 2012 to 2020. Researchers pulled data from the United States Renal Data System and Early Steps to Transplant Access Registry and followed patients through 2021.
The main objective was to analyze factors influencing the timing of evaluations for kidney transplant. The primary outcome sought to find whether patients began the evaluation process at a transplant center within 6 months of referral.
Overall, 51% of patients referred from dialysis facilities to transplant centers started evaluation process within 6 months. In addition, researchers found the median odds ratio for variation between transplant centers was higher than that for dialysis facilities, meaning disparity “was more apparent among transplant centers.”
Given this, “our study findings support the prior calls and recently announced [Health Resources and Services Administration] HRSA directive to expand [Organ Procurement and Transplantation Network] OPTN data collection to include national data on referral and start of the transplant evaluation among patients with kidney failure,” McPherson and colleagues wrote. “This effort will enhance our understanding of how transplant centers influence these critical first steps in the kidney transplant process.”