Kidney Week

Abstract: SA-OR074

Optimizing Timing for Kidney Transplant Wait-Listing

Session Information

• Transplantation: Clinical Controversies in Donation, Access, Monitoring, and Treatment
  November 08, 2025 | Location: Room 370A, Convention Center
  Abstract Time: 04:40 PM - 04:50 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham, PhD

• Shahinian, Vahakn, University of Michigan Medical School, Ann Arbor, Michigan, United States

Vahakn Shahinian, MD

• Powe, Neil R., University of California San Francisco, San Francisco, California, United States

Neil R. Powe, MD, FASN

• Doshi, Mona D., University of Michigan Medical School, Ann Arbor, Michigan, United States

Mona D. Doshi, MBBS

• Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States

Rajiv Saran, MD, MBBS, MS

Background

Criteria to qualify for kidney transplant waitlisting time only requires an eGFR ≤20 ml/min/1.73m². It does not consider other factors highly predictive of ESRD or death, namely albuminuria, age, and sex. We propose that including risk of progression as a criterion for waitlisting will produce improved distribution of cadaveric kidneys and better outcomes.

Methods

Utilizing data on ~1 million US Veterans (2022), aged 18+ years with complete information on eGFR and albuminuria, we used the Kidney Failure Risk Equation (KFRE) to estimate 2-year risk of ESKD. By employing the 25^th percentile of 2-year risk of ESKD (~25% risk) as a potential cut point, we compared the characteristics of Veterans listed under the current and KFRE-based criteria.

Results

When examining Veterans with eGFR ≤20 ml/min/1.73m², the range of 2-year risk of ESKD was 0.1% to 99.9%, with a median of 46.2%. A total of 10,368 would be eligible for waitlisting by one or both criteria (~60% by both, ~20% by only one of the two criteria). Patient characteristics vary greatly by criteria used. Those who would only qualify by the eGFR ≤20 criterion are much older compared to those who would qualify by KFRE ≥25% (71 vs. 53 years). Using the KFRE criteria only, more males, minorities (Hispanic, Black, Asian), and those with diabetes and/or albuminuria would be waitlisted. Death and hospitalization rates were similar in all groups and although progression to ESKD within the same year was rare, it was highest among those with KFRE ≥25%. This group was also more likely to have seen a nephrologist during the year.

Conclusion

Considering changing the waitlisting criteria for kidney transplantation to include risk of CKD progression has the potential to both be fairer and could lead to better outcomes by transplanting younger patients who are more likely to progress to ESKD. Future work will include assessment of more long-term outcomes and competing risk of death.

Funding

• Other U.S. Government Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025g3sfdte0