Kidney Transplantation Contraindications: Variation in Nephrologist Practice and Training Vintage

Area of Science:

• Nephrology
• Transplantation Medicine
• Medical Education

Background:

• Increasing access to kidney transplantation is a key health system goal.
• Nephrologists' referral decisions significantly influence patient access to transplantation.
• Little is known about how nephrologists' training vintage affects their interpretation of patient suitability criteria.

Purpose of the Study:

• To examine how nephrologists assess adult patients for kidney transplant suitability.
• To quantify variation in nephrologist restrictiveness when interpreting clinical and psychosocial criteria.
• To test the association between nephrologist age (as a proxy for training vintage) and referral restrictiveness.

Main Methods:

• A novel, iteratively validated survey was administered to US-based nephrologists.
• The survey assessed the interpretation of 7 clinical and 7 psychosocial patient criteria.
• Logistic regression models were used to analyze the association between nephrologist age and restrictiveness, controlling for covariates.

Main Results:

• Nephrologists showed inconsistent interpretation of patient criteria, with lower consistency for psychosocial factors.
• Older nephrologists were more likely to interpret criteria restrictively (odds doubled per decade of age, aOR 1.96).
• This age-related restrictiveness was significant for psychosocial criteria (aOR 3.18) but not clinical criteria.

Conclusions:

• Nephrologists exhibit significant variability in interpreting kidney transplant evaluation criteria.
• Nephrologist age is associated with more restrictive interpretation, especially concerning psychosocial factors.
• Educational interventions targeting guideline-based criteria could be tailored by age to improve referral consistency.