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Kidney Week

Abstract: FR-PO1037

Living Kidney Donor Evaluation Time and Pre-emptive Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Habbous, Steven, Western University, London, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
Background

A pre-emptive kidney transplant avoids the risks of initiating dialysis and may result in better outcomes than other treatment options available to patients with kidney failure.

Methods

Using healthcare databases in Ontario, Canada, we retrospectively studied 478 living donor kidney transplants from 2004-2014 where the recipients were not receiving dialysis when their donors’ evaluation was underway (for at least three months). We assessed how often dialysis was initiated before transplantation, and explored factors associated with a higher likelihood of dialysis initiation prior to transplant. Results are presented as median (25th, 75th percentile).

Results

A total of 167/478 (35%) of patients with kidney failure initiated dialysis 9.7 (5.4, 18.7) months after their donor candidate began their evaluation, and received dialysis for 8.8 (3.6, 16.9) months before transplantation. The total cost of initiating and receiving dialysis was CAD $8.1 million and 44/167 (26%) patients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 (6.4, 21.6) months for pre-emptive transplants and 22.4 (13.1, 38.7) months for donors whose recipients started dialysis prior to transplant. Characteristics associated with a higher likelihood of the recipient initiating dialysis prior to transplantation included donor female sex, non-white donors, lower donor and recipient neighbourhood income quintile, and a longer time until the transplant program received the recipient referral. Results varied across transplant centres.

Conclusion

One-third of living donor kidney transplant recipients start dialysis prior to transplantation with significant costs to the healthcare system.

Distribution of living donor evaluation times by recipient dialysis status when the living donor started the evaluation. Recipients who started dialysis before transplant were potential pre-emptive transplants lost.

Funding

  • Government Support - Non-U.S.