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Abstract: SA-PO802

Death on Kidney Transplant Waitlist: Clues to Better Listing Decision Making

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Mendonca, Ninoshka, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Mehta, Jaya, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Paramesh, Anil S., Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Jeon, Hoonbae, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Killackey, Mary, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Vijay, Adarsh, Tulane University School of Medicine, New Orleans, Louisiana, United States

Group or Team Name

  • Tulane Transplant
Background

Wait-list mortality with risk adjustment is one of the pre-transplant metrics currently used for monitoring transplant program performance. Understanding risk factors and mortality trends in wait-listed kidney transplant candidates are essential to implement better screening protocols and better listing decision making.

Methods

We performed a single-center five-year retrospective study of kidney transplant candidates who were accepted to the transplant wait-list between January,2012 and December,2016. Characteristics of transplanted recipients[TG] were compared with candidates that expired[EG] on the kidney transplant waitlist.

Results

A total of 266 patients on the transplant wait-list were included in our study, of which 185(70%) were transplanted and 81(30%) expired. The groups were comparable with respect to gender,ethnicity,BMI,blood type,functional status at listing,history of previous transplants and history of prior malignancy. Our analysis showed median age at listing was lower in TG in comparison to EG(47 vs 51 years;p=0.001). Average length of time spent on the transplant waitlist was higher in EG(884 vs 819 days;p=0.50). The occurrence of polypharmacy(>5 medications) was higher in EG in comparison to TG(92%vs81%;p=0.017) along with the increased use of blood-thinners in the EG group(49%vs34%;p=0.018). We also found that 98% of patients in the EG group had a diagnosis of hypertension at the time of listing in comparison to 88% in the TG group(p=0.01). When comparing groups,61% of the EG patients were diabetic in comparison to only 31% of TG patients. Similarly, the median HbA1c as well as the use of insulin was significantly higher in EG patients(7.1vs5.6;p=0.0001, 41%vs19%;p=0.0002). A higher proportion of patients in TG had EF>50% on pre-listing echo than patients in EG(68%vs56%;p=0.09). 51 patients(63%) in EG underwent heart catherization in comparison to 88 patients(48%) in TG. However, the percentage of positive heart catheterizations were higher in the TG 28%vs21% in EG.

Conclusion

Our study shows greater mortality risk in wait-listed kidney transplant candidates with EF<50%,poorly controlled diabetes,poly-pharmacy and use of blood thinners. The discrepancy in positive heart catheterization rates should alert future prospective trials to further streamline cardiac screening protocols in kidney transplant candidates.