Abstract: SA-PO1066
Difficult Retransitions of Care: Qualitative Analysis of Semi-Structured Interviews of Nephrologists Regarding Dialysis and Retransplant After Graft Failure
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Knapp, Christopher D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Hart, Allyson, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Schaffhausen, Cory, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Ku, Elaine, University of California San Francisco, San Francisco, California, United States
- McKinney, Warren T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background
Despite long term receipt of nephrology care, uptake of home dialysis and re-transplantation in kidney transplant recipients (KTRs) who face graft failure remains suboptimal. The objective of this study was to examine provider practices and perspectives with respect to promoting home dialysis and re-transplantation in this population.
Methods
We conducted remote interviews with nephrologists recruited from nine transplant centers who care for KTRs with graft failure. We analyzed qualitative data using grounded theory and a constant comparative method to capture emergent themes.
Results
13 nephrologists completed interviews. Five worked exclusively with transplant patients and eight saw both transplant patients and chronic dialysis patients. Four key themes emerged from the analysis. (Figure 1). 1.Providers were confident in their ability to discuss medical aspects of graft failure. This included confidence with respect to identifying risks, benefits, and medical contraindications of each kidney replacement therapy modality. 2.Providers reported heterogenous approaches to how their practices and referral centers organized the care for the graft failure population. 3. Providers had clear preferences, primarily to prioritize re-listing and secondly to place patients on a home dialysis modality. 4. Barriers to care and suggestions for improvement fell into two domains: patient specific factors and systemic factors.
Conclusion
Providers expressed confidence in their care for KTRs with graft failure, and a clear preference for re-transplantation, as well as home dialysis if needed. However, providers and centers had heterogenous mechanisms to facilitate patients accessing re-transplant and home dialysis services, such as different clinical standards for returning patients to general nephrologists when patients face graft failure. Future research could focus on developing dedicated clinical pathways to ensure optimal care for these patients.
Funding
- NIDDK Support