Abstract: PUB481
Main Obstacles of Pre-kidney Transplant Work-Up: A Quality Assessment/Process Improvement Program
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Elsebaie, Abdelrahman, Queen's University, Kingston, Ontario, Canada
- Witton, Natalie, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Hopman, Wilma M., Queen's University, Kingston, Ontario, Canada
- Holland, David C., Queen's University, Kingston, Ontario, Canada
- Shamseddin, M. Khaled, Queen's University, Kingston, Ontario, Canada
Group or Team Name
- Kingston Kidney Transplant Program (KKTP).
Background
Failure to complete a comprehensive pre-kidney transplant workup results in increased dialysis exposure and poorer post-transplant survivals. Failure also puts stress on transplant centers’ resources, as referrals continue to come, patients who are in ‘pending activation limbo’ are either neglected or detract from new patients’ evaluation. Candidates are worked-up by our transplant program after referral rather than by the dialysis programs where candidates are universally referred to transplant centres after finalizing workup. We are aiming to assess metrics of quality at our program focusing on variability in the time taken for completion of pre-transplant workup among different coordinators, processes, and populations.
Methods
This is a single center retrospective study evaluating the duration and obstacles of pre-kidney transplant workup of all in limbo candidates who were evaluated at our program prior to January 1, 2021. Data will be compared with candidates’ workup during a later period, when a more regular chart review was adopted by our newer coordinator to expedite workup.
Results
112 candidate’s files were reviewed by January 1, 2021. 54 (48.2%) candidates were in limbo [Age 54.5±10.7 years, female (44.4%), Caucasian (74.1%)], 38 files were closed due to patients’ wishes or nonadherence and 20 others had expired. By March 1, 2024, 47 (87%) in limbo candidates received a transplant decision while 7 patients stayed in workup. Median time from assessment to transplant decision was 23.3 (14.3-37.1) months, while time from chart review to transplant decision was 7.7 (3-16) months. Patients who are still in workup live further away from our center, were assessed once (P 0.035), and have a longer median workup to date 44.6 (42.4-55.7) months. The median time to transplant decision of candidates with more frequent pre-transplant assessments compared with those with less frequent assessments was shorter (20.2 vs 27.1 months, P 0.037). Finally, at the time of transplant decision, 38 (81%) patients were on dialysis (24 on dialysis > 24 months, 9 (24%) on dialysis < 1 year).
Conclusion
Regular chart review and frequent assessments of pre-transplant candidates result in shorter workup and dialysis vintage.