Kidney Week

Abstract: TH-PO1129

The Kidney Transplant Fast Track (KTFT) Intervention Reduced Time to Kidney Transplant Waitlisting

Session Information

• Late-Breaking Posters
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Myaskovsky, Larissa, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Larissa Myaskovsky,

• Kalaria, Arjun Lalit, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Arjun Lalit Kalaria,

• Puttarajappa, Chethan M., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Chethan M. Puttarajappa,

• Ng, Yue-Harn, University of Washington School of Medicine, Seattle, Washington, United States

Yue-Harn Ng,

• Leyva, Yuridia, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Yuridia Leyva,

• Zhu, Yiliang, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Yiliang Zhu,

• Velez-Bermudez, Miriam E., University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States

Miriam E. Velez-Bermudez,

• Bryce, Cindy L, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States

Cindy L Bryce,

• Chang, Chung-Chou H., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Chung-Chou H. Chang,

• Boulware, L. Ebony, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

L. Ebony Boulware,

• Tevar, Amit D., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Amit D. Tevar,

• Dew, Mary Amanda, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Mary Amanda Dew,

Background

Kidney transplantation (KT) is the optimal treatment for end-stage kidney disease (ESKD), but the KT evaluation process is lengthy, time consuming, and burdensome to patients. In December 2012, our transplant center implemented a one-day streamlined and coordinated-care evaluation process, Kidney Transplant Fast Track (KTFT), but it has not been evaluated for efficacy (i.e., reduced time to waitlisting and KT receipt).

Methods

In 2015, we initiated a quasi-experiment to determine the efficacy of the KTFT (n=1118) compared to usual care historical controls (n=1152) from our previous cohort study. We conducted a pre-transplant workup interview with all participants and followed their transplant status via medical record review through 08/2022. Also, we examined whether cultural factors (e.g., medical mistrust, health literacy, religious objection) predicted time to waitlisting and KT. We used Fine-Gray proportional hazards modeling to examine predictors of time from evaluation to waitlisting and KT receipt, controlling for demographic and medical factors.

Results

Over a 7-year follow-up period, compared to historical controls, KTFT patients had a 44% greater chance of being wait-listed (SHR=1.44, CI=1.26-1.63, p<.0001). There was a non-statistically significant trend toward higher KT rates. Greater medical mistrust or religious objections to transplantation uniquely predicted time to waitlisting. Medical mistrust, religious objection, and lower health literacy also uniquely predicted longer time to KT.

Conclusion

We developed an effective streamlined coordinated care evaluation process for ESKD patients that reduced the time to complete evaluation and increased the rates of transplant waitlisting. We also identified unique cultural predictors of barriers to waitlisting and KT.

Funding

• NIDDK Support