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Abstract: SA-PO097

The Impact of Systematic Review of Status 7 Patients on the Kidney Transplant Waitlist

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Kataria, Ashish, Erie County Medical Center, Buffalo, New York, United States
  • Venuto, Rocco C., Erie County Medical Center, Buffalo, New York, United States
  • Von Visger, Jon R., Erie County Medical Center, Buffalo, New York, United States
  • Chang, Shirley Shwu-Shiow, Erie County Medical Center, Buffalo, New York, United States
  • Lamphron, Bryan, Erie County Medical Center, Buffalo, New York, United States
  • Shah, Vaqar H., University at Buffalo, Buffalo, New York, United States
  • Gundroo, Aijaz A., Erie County Medical Center, Buffalo, New York, United States
Background

Patients (pts) listed status 7 on the kidney transplant (Tx) waitlist are more likely to die rather than be transplanted. They need to overcome one or more barriers in order to move to status 1. These barriers could either be medical or psycho-social (PS) but are significant enough to exclude them from recieving organ offers. We speculated that by systematically re-evaluating status 7 pts, we might overcome the barriers and expedite their Tx.

Methods

Biweekly status 7 re-evaluation meetings were started in April 2016 and continued through April 2018. The attendees were a transplant physician champion and members of all components of the transplant team. These were held in parallel to the recipient selection meetings. For each status 7 patient, the attendees performed an intense scrutiny of the individual barriers against activation and developed a specific action plan. A descriptive analysis of the status 7 pts at the start and end of study was performed and patient demographic and listing outcomes were studied.

Results

A total of 266 status 7 pts were evaluated(Table1). 18.4% of them overcame remaining barriers preventing activation and majority (85.7%) in this group recieved a Tx after being inactive on the waitlist for average 805 days. 39% of inactive patients were deemed ineligible and were removed from the waitlist. These pts were older than those who recieved a Tx (mean age 60.6 versus 52.7 years) and were inactive for average 1593 days. 17.6% status 7 pts died while only 73 (27.4%) pts still remain inactive on the waitlist. Common barriers against activation were CP and PS issues in all categories.

Conclusion

Re-evaluation of status 7 pts has the potential to expedite their transplantation or removal of those pts from the waitlist who are unlikely to get activated for a kidney Tx. We have incorporated this process on a continuing basis.

Current waitlist statusStatus 7Activated and/or transplantedDiedRemoved from the waitlist
Number of patients(%)73(27.4%)49(18.4%) activated; 42 of these transplanted47(17.6%)104(39%)
Mean age (years)51.353.459.360
Common barriers against activation(%)CP(52)
PS(30)
CP(41)
PS(33)
Onc(17)
CP(54)
PS(21)
Onc(15)
I(13)
CP(46)
PS(26)
Onc(10)
Average inactive duration (days)168580511981593

CP-Cardio-pulmonary, PS-Psycho-social, Onc-Oncologic, I-Infection