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Updated: Jul 10, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
The overlapping risk profile between dialysis patients listed and not listed for renal transplantation
J D Schold1, T R Srinivas, L K Kayler
1Department of Medicine, and Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA. scholjd@medicine.ufl.edu
Insights
Many end-stage renal disease (ESRD) patients suitable for kidney transplantation are not listed, while higher-risk individuals are listed rapidly. This indicates potential disparities in accessing this life-saving procedure.
Area of Science:
- Nephrology
- Transplantation Medicine
- Health Services Research
Background:
- Kidney transplantation offers survival benefits for end-stage renal disease (ESRD) patients.
- Patient selection for transplantation involves identifying suitable candidates and excluding high-risk individuals.
- Limited data exists on the effectiveness of current screening strategies in optimizing transplant listing.
Purpose of the Study:
- To estimate the life expectancy of adult ESRD patients in the U.S. before transplantation.
- To examine factors associated with transplant listing based on patient prognosis.
- To assess whether current practices align with listing the most appropriate candidates.
Main Methods:
- Analysis of adult ESRD patients with onset between 1995 and 2003 in the United States.
- Estimation of pre-transplant life expectancy on dialysis.
- Examination of demographic and clinical factors influencing transplant listing decisions.
Main Results:
- One-third of listed patients had a life expectancy of 5 years or less on dialysis.
- Conversely, one-third of unlisted patients had a life expectancy greater than 5 years.
- Significantly more unlisted patients had a 'good' prognosis (134,382) compared to listed patients with 'poor' prognosis (16,807).
- Age, race, gender, insurance, and BMI influenced listing for 'poor' prognosis and non-listing for 'good' prognosis.
Conclusions:
- Current transplant listing practices may not effectively prioritize patients with the best prognosis.
- Disparities in listing exist, with higher-risk patients being listed rapidly and viable candidates overlooked.
- Further research is needed to refine selection criteria and ensure equitable access to kidney transplantation.
Abstract:
The survival advantage of kidney transplantation extends to many high-risk ESRD patients; however, numerous factors ultimately determine which patients are evaluated and listed for the procedure. Broad goals of patient evaluation comprise identifying patients who will benefit from transplantation and excluding patients who might be placed at risk. There is limited data detailing whether current access limitations and screening strategies have achieved the goal of listing the most appropriate patients. The study estimated the life expectancy of adult patients in the United States prior to transplantation with ESRD onset from 1995 to 2003. Factors associated with transplant listing were examined based on patient prognosis after ESRD. Approximately one-third of patients listed for transplantation within 1 year of ESRD had 5-year life expectancy. The number of patients not listed with 'good' prognosis was significantly higher than those listed with 'poor' prognosis (134 382 vs. 16 807, respectively). Age, race, gender, insurance coverage and body mass index (BMI) were associated with likelihood for listing with 'poor' prognosis and not listing with 'good' prognosis. Over the past decade, many ESRD patients viable for transplantation have not listed for transplantation while higher-risk patients have listed rapidly.
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