Effect of Physical Function on Access to Repeat Kidney Transplantation.

Area of Science:

• Nephrology
• Transplantation Immunology
• Geriatric Medicine

Background:

• Kidney transplantation success rates are suboptimal, necessitating repeat procedures for over half of recipients.
• Repeat transplant candidates often present with advanced disease, comorbidities, and functional limitations due to aging and immunosuppression.
• Limited physical function impacts initial transplant access, but its role in repeat transplantation access is unknown.

Purpose of the Study:

• To investigate the influence of physical function on wait-listing for repeat kidney transplantation.
• To identify factors associated with access to repeat kidney transplant wait-lists.

Main Methods:

• Analysis of a national registry dataset comprising 28,884 kidney transplant recipients.
• Assessment of physical function using Karnofsky scores (total assistance, some assistance, no assistance).
• Application of logistic regression and Cox proportional hazard models to evaluate wait-listing access and time.

Main Results:

• Patients with higher physical independence demonstrated increased likelihood of wait-listing for repeat kidney transplantation.
• Factors associated with reduced wait-listing included high sensitization, diabetes, Black race, and older age.
• Limited physical function, within the work-up process, correlated with a shorter duration to wait-listing post-graft failure.

Conclusions:

• Promoting and supporting physical function is essential for improving access to repeat kidney transplantation.
• Enhanced physical function may lead to better outcomes for patients undergoing repeat kidney transplantation.