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Abstract: SA-OR005

Variation in Access to Transplant Referral and Evaluation Start among Dialysis Facilities

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • McPherson, Laura J., Emory University School of Medicine, Atlanta, Georgia, United States
  • Dubay, Derek, Medical University of South Carolina, Charleston, South Carolina, United States
  • Ellis, Matthew Jay, Duke University Medical Center, Durham, North Carolina, United States
  • Jones, Heather, Vidant Medical Center, Greenville, North Carolina, United States
  • Zayas, Carlos F., Augusta University (MCG) School of Medicine, Augusta, Georgia, United States
  • Mulloy, Laura L., Medical College of Georgia, Augusta, Georgia, United States
  • Thrasher, Brenda B., Carolinas Medical Center, Charlotte, North Carolina, United States
  • Gulotta, Joseph A., IPRO, Lake Success, New York, United States
  • Wright, Shannon, IPRO ESRD Network of the South Atlantic, Morrisville, North Carolina, United States
  • Hamoda, Reem, Emory University School of Medicine, Atlanta, Georgia, United States
  • Pastan, Stephen O., Emory University School of Medicine, Atlanta, Georgia, United States
  • Patzer, Rachel E., Emory University School of Medicine, Atlanta, Georgia, United States

Group or Team Name

  • on behalf of the Southeastern Kidney Transplant Coalition

Variation exists in transplant access across US dialysis facilities. However, little is known about the proportion of end-stage renal disease (ESRD) patients who initiate or complete transplant steps prior to waitlisting. We describe dialysis facility-level variation in referral and evaluation start among dialysis facilities in ESRD Network 6 using our regional pre-transplant data registry.


In collaboration with the community-based Southeastern Kidney Transplant Coalition, patient-level data from all 9 transplant centers in ESRD Network 6 (GA, NC, and SC) on kidney transplant referral (date referral form was received by transplant center) and evaluation start (date patient started evaluation) were collected from January 1, 2012 to December 31, 2016. Referral and evaluation start data were linked with ESRD Network data, including prevalent patients by dialysis facility and year, to calculate the proportion of patients referred and starting evaluation.


Among 47,804 prevalent dialysis patients from all ESRD Network 6 dialysis facilities in 2016 (n=705) with a median of 60 patients/facility, approximately 16.1% (n=7717) were referred for evaluation and 9.2% (n=4406) started an evaluation. The median proportion of patients referred in 2016 was 14.5% (IQR: 8.9-21.2%), with 48 facilities not referring any patients (Figure 1). The median proportion of patients starting an evaluation in 2016 was 7.7% (IQR: 4.2-12.2%); 67 facilities had no patients start evaluation in 2016.


In the Southeastern United States, a small proportion of dialysis patients are referred for kidney transplant evaluation, and fewer start the evaluation at a transplant center. There is considerable variation in the proportion of patients referred and starting evaluation across dialysis facilities in ESRD Network 6. Interventions targeting these early steps in the kidney transplant process could improve equitability in transplant.


  • NIDDK Support