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Abstract: TH-PO1144

Utilizing the Estimated Post-Transplant Survival Score (EPTS) to Assess Dialysis Facility Referral for Pre-Transplant Evaluation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Harford, Antonia, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Paine, S., Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Jiang, Huan, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Sanders, Ronald, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Gul, Ambreen, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Zager, Philip, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
Background

Although transplant (txp) is the optimal treatment for End Stage Kidney Disease (ESKD), only ~ 15% of prevalent patients (pts) are waitlisted annually. It is estimated that approximately half of ESKD pts would have a survival advantage from txp. The 4-factor (age, vintage, diabetes, & prior txp) EPTS in conjunction with the Kidney Donor Profile Index maximizes the use of donor kidneys with the highest predicted survival by allocating them to potential recipients with the highest predicted post txp survival. Lower EPTS is associated with higher projected longevity. With the exception of diabetes, the 4 factor EPTS does not include comorbidities. We calculated EPTS for incident ESKD pts cared for in outpatient dialysis facilities operated by a nonprofit provider, to determine if pts with a favorable prognosis were being appropriately referred for evaluation.

Methods

We studied 14,043 hemodialysis (HD) & 2,739 peritoneal dialysis (PD) pts, 18 -71 years who started dialysis between 2009-2018 & were followed for 1 year unless transplanted. SAS & R statistical packages were utilized for data analysis.

Results

EPTS distributions in HD & PD pts differed (see figure). The median (IQR) scores were 36 (19- 54) & 29 (14- 46) in HD & PD pts, respectively. Overall, 47.9% of HD & 71.0% of PD pts were evaluated in the first year. The % pts in the lowest EPTS quintile was higher among PD (36.7%) vs. HD (27.9%) pts. Among pts with the best predicted longevity by EPTS, 41.3% HD vs. 20.9% PD pts were not evaluated in the first year. Reasons included patient referred but not evaluated, patient refusal of referral, medically unsuitable or unknown reason.

Conclusion

Overall, the present referral practices within this nonprofit dialysis provider demonstrate that pts are being actively referred for pre-txp evaluation. Better referral rates & EPTS scores among PD vs. HD pts likely reflect the overall health of those pts selected for home dialysis. EPTS use in conjunction with an incident comorbidity review will allow dialysis facilities to optimize transplant referral practices.

Funding

  • Commercial Support