Access to the kidney transplant wait list.

Area of Science:

• Nephrology
• Transplantation Medicine
• Healthcare Access

Background:

• Patient selection for kidney transplantation is complex.
• Understanding referral patterns and contraindications in end-stage renal disease (ESRD) is crucial for equitable access.
• The role of comorbidity indices in predicting transplant status requires further investigation.

Purpose of the Study:

• To examine kidney transplant selection processes.
• To identify factors influencing referral and contraindication status in ESRD patients.
• To determine if comorbidity indices predict transplant eligibility.

Main Methods:

• Retrospective analysis of 113 incident adult ESRD patients.
• Assessment of referral status based on published guidelines.
• Evaluation of contraindications and comorbidity indices (Charlson, ESRD).
• Comparison of 'Candidate' versus 'Neither' patient groups.

Main Results:

• 41.6% of ESRD patients were referred for kidney transplantation.
• 42.5% had a contraindication, while 23% were neither referred nor had contraindications.
• Age was the most significant discriminator between referred and non-referred patients without contraindications.
• ESRD mortality score predicted referral and contraindication status; comorbidity indices were less predictive.

Conclusions:

• Age is a key factor in kidney transplant selection, more so than comorbidity indices.
• A notable proportion of ESRD patients are not referred despite lacking contraindications.
• Further research is needed to assess the transplant benefit for 'Neither' patient group.