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American Journal of Kidney Diseases

Rates of Completion of the Medical Evaluation for Renal Transplantation

  • Francis L. Weng
    Correspondence
    Address reprint requests to Francis L. Weng, MD, MSCE, Saint Barnabas Medical Center, Transplant Division, 94 Old Short Hills Road, Livingston, NJ 07079
    Affiliations
    Department of Medicine, Renal-Electrolyte and Hypertension Division; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Marshall M. Joffe
    Affiliations
    Department of Medicine, Renal-Electrolyte and Hypertension Division; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Harold I. Feldman
    Affiliations
    Department of Medicine, Renal-Electrolyte and Hypertension Division; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Kevin C. Mange
    Affiliations
    Department of Medicine, Renal-Electrolyte and Hypertension Division; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA
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Published:August 22, 2005DOI:https://doi.org/10.1053/j.ajkd.2005.06.011
      Background: Failure to complete the medical evaluation for renal transplantation may impede access to transplantation and preclude the possibility of preemptive transplantation. We sought to (1) characterize completion rates of the transplantation medical evaluation and (2) determine factors associated with completion of the evaluation. We hypothesized that patients not on dialysis therapy complete the evaluation process more quickly than patients receiving dialysis. Methods: Between September 2002 and September 2003, a total of 175 patients who were evaluated for renal transplantation at the Hospital of the University of Pennsylvania were enrolled in a prospective cohort study. Patients completed a self-administered questionnaire. The progress of patients’ medical evaluations, including completion of requested tests and evaluations, was extracted from the electronic medical record. Results: During follow-up, 100 patients (57.1%) completed the evaluation, including tests and evaluations requested by the transplant team, whereas 49 patients (28.0%) had tests still pending. The remaining patients died (2.3%), lost interest in transplantation (1.1%), or were immediately (7.4%) or later (4.0%) declared medically ineligible for transplantation. In the multivariable Cox proportional hazards model, black race (adjusted hazard ratio, 0.63; 95% confidence interval, 0.40 to 1.00; P = 0.05) was associated with time to completion of the transplantation evaluation, but receiving maintenance dialysis at the time of the initial transplantation evaluation was not (adjusted hazard ratio, 0.92; 95% confidence interval, 0.60 to 1.42; P = 0.72). Conclusion: Completion of the medical evaluation for transplantation is slower in blacks than nonblacks. We were unable to detect a significant difference between dialysis and nondialysis patients in rates of completion of the evaluation.

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      Linked Article

      • Racial Disparities and Transplantation
        American Journal of Kidney DiseasesVol. 46Issue 4
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          IN THIS ISSUE of the American Journal of Kidney Diseases, Weng et al1 report on rates of completion of the evaluation process to be placed on the cadaveric kidney transplant waiting list. The authors included 175 patients who had advanced chronic renal failure (soon to require dialysis or transplantation) or who were stable on dialysis therapy. All patients wished to be evaluated for transplantation, and the time to completion of evaluation and placement on the waiting list was longer in black patients than in others.
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