Outcomes of Patients Deemed Ineligible for Kidney Transplantation

Kidney transplantation (KT) offers superior outcomes for patients with end-stage kidney disease (ESKD), yet many are excluded due to various reasons. Understanding exclusion factors and associated outcomes is essential.

We retrospectively analyzed 835 ESKD patients from our center, including 152 evaluated between 1997 and 2017 and deemed ineligible for KT: 49 for nonmedical reasons (NMRs, e.g., nonadherence) and 103 for medical reasons (MRs, e.g., comorbidities or surgical contraindications). Outcomes were compared to a control group of 683 kidney transplant recipients (KTRs) between 2003 and 2017 from our center. Baseline characteristics were compared using Kruskal-Wallis and chi-square tests. Survival differences were assessed using inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis, and weighted Cox proportional hazards models.

Nonadherence and/or incomplete evaluation (32.2%) was the leading NMR, and surgical contraindication (20.4%) was the main MR for ineligibility. KTRs were younger (median age: 51 vs. 55 in NMR vs. 60 years in MR, respectively; p < 0.001) and had lower prevalence of diabetes mellitus (13.6% vs. 40.8% vs. 44.7%, p < 0.001), coronary artery disease (13.9% vs. 55.1% vs. 69.9%, p < 0.001) compared to the NMR and MR groups, respectively. IPTW-adjusted Kaplan-Meier analysis demonstrated the poorest survival in the MR group, followed by NMR, and the best in KTRs (p < 0.001). In weighted Cox models, MR (HR = 6.22, 95% CI: 3.44-11.2) and NMR (HR = 2.20, 95% CI: 1.21-3.98) groups had significantly higher mortality risk than KTRs.

Nonmedical KT ineligibility is common and associated with inferior survival compared to KTRs. Targeted interventions to address modifiable barriers are warranted.