Candidate comprehension of key concepts in kidney transplantation

Although kidney transplant candidates receive education regarding transplantation and donation, little is known about the extent of their comprehension. We aimed to identify factors that affect patient comprehension of important concepts regarding kidney transplantation.

We performed a cross-sectional survey of consecutive adult kidney transplant candidates seen at our center between July 2013 and October 2013 for initial evaluation (n=100) or for reevaluation (n=117). The main outcome measure was a Knowledge Assessment Questionnaire completed by patients. We assessed factors affecting patient understanding of key kidney transplant concepts as measured by mean knowledge score.

Mean knowledge scores of those at evaluation (72±21) and those at reevaluation (70±20; p=0.4769) were similar; therefore the entire cohort was analyzed as a single group. Compared to the high-scoring group, low-scorers (<75%; median value) were significantly more likely to be older, Hispanic, with lower education attainment, and have end-stage renal disease due to hypertension or diabetes rather than other etiologies. On multivariate analysis, independent risk factors for low-scores were increasing age (aOR 1.03 (95% CI 1.01-1.06) and educational level (less than high school; aOR 4.23, 95%CI 1.82-9.80; high school or GED aOR2.85, 95% CI 1.43-5.70 compared to some college or technical school). Of 139 candidates that consented to receive ECD and 152 consenting to CDCHR kidneys, 52% and 27%, respectively, answered the high-risk-specific question incorrectly.

Educational level and older age are independent risk factors for poor comprehension. Kidney candidate knowledge of organs with increased risks is suboptimal despite previous consent to receive such organs.