New Tools and a Population-Based Approach to Improve Kidney Transplant Opportunity and Preemptive Waitlisting

While kidney transplantation provides longer survival and improved quality of life, there are numerous barriers to access. Provider-led discussions and early referrals are critical for improving access. However, reducing variability in referrals and addressing barriers through standardizing documentation of transplant option discussion and systematically tracking CKD care can be impactful.

We identified advanced CKD patients from an integrated health care system using a population-based approach. We used new electronic health record (EHR) tools, searchable system-wide, to require documentation of transplant discussion and evaluated over five years the number of CKD patients within the kidney transplant continuum and individual patient characteristics.

At baseline, we identified 1747 patients with an eGFR ≤20 mL/min/1.73 m². Of those, 554 (31.7%) were in the transplant continuum (referred, evaluated, and waitlisted). After the EHR tool was implemented, documentation of transplant discussion improved to 100% within a few months. At five-year follow-up, the transplant continuum population almost doubled from 554 to 974. Those added after the intervention were older (p = 0.003) and more likely to identify as Black (p = 0.006). Of the waitlisted patients, 65% were referred to transplant centers before starting dialysis. For incident CKD members, outside the cohort, the transplant documentation rate and referrals also remain high with the referral volume per year steadily increased from 233 to 369, and kidney transplant volume per year also steadily increased from 89 to 141.

This study demonstrates that a new, yet simple, EHR tool can be impactful for sustainably increasing documentation of transplant option discussion, waitlisted members, and transplant opportunity.