Abstract: TH-PO1142
Non-Candidacy for Kidney Transplant: An Experience from Rural Eastern North Carolina
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Basuli, Debargha, East Carolina University, Greenville, North Carolina, United States
- Samuel, Geetha, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
- Lai, Hsiao Ling, East Carolina University, Greenville, North Carolina, United States
- Dadzie, Samuel, ECU Nephrology & Hypertension, Greenville, North Carolina, United States
Background
Kidney transplant is the optimal therapy for the end-stage renal disease patients in order to improve the expectancy and quality of life. Recently there are many studies investigating how to improve the referral process to improve the access to kidney transplantation. However, there is not much data looking into the rate and causes disapproval of these referred patients by the transplant program to be activated in the waiting list. Thus it is important to study the disapproved population so that we can identify the barriers and intervene to improve kidney transplant rates.
Methods
The electronic health records of 309 ESRD patients undergoing dialysis by one major dialysis practice, East Carolina University were accessed manually to obtain information about the referral by the nephrologists for a transplant and the decision of the transplant selection committee. Disapproval rate for transplant was calculated by percent, and any disparities in disapproval was measured based on gender and race of the patients. Statistical analysis was conducted with t-test and a p<0.05 was considered significant.
Results
Our preliminary data shows although all ESRD patients were referred for transplant within 1 year of initiation of dialysis, about 63 percent of the referred ESRD patients were initially disapproved for further evaluation for a transplant. 40 percent of these patients were disapproved because of modifiable factors like smoking, alcohol abuse, overweight, not completing age appropriate screening tests. Only 40% of these patients were able to successfully modify the risk factors and were accepted as transplant candidates in following transplant evaluation visits. Interestingly, 83% of the disapproved patients were African-Americans, and 41% were females.
Conclusion
Our reports shows that there are major barriers to transplant in ESRD patients in eastern North Carolina even after patients have been referred early. Majority of the disapproved patients were African-Americans and only less than half of the patients with modifiable risk factors were able to be enlisted for transplant after proper intervention. More quality improvement endeavors are required to reduce the disparity in race and to support ESRD patients to overcome modifiable barriers to improve transplant rates in this population.