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Kidney Week

Abstract: SA-PO949

Expedited Main Obstacles of Prekidney Transplant Workup: A Quality Improvement Study

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 in a timely fashion results in increased dialysis exposure, poorer post-transplant survival, and higher resource demands. Candidates undergo workup by our transplant program post-referral rather than by their dialysis programs. We aimed to assess quality metrics at our program, focusing on variability in the duration of pre-transplant workup after adopting a more frequent and scheduled chart review process by our newer coordinator to expedite pre-transplant workup.

Methods

This is a retrospective study evaluating the duration and obstacles of the pre-kidney transplant workup of all candidates evaluated at our transplant program between January 1, 2021, and December 31, 2022, after adopting a more regular chart review process by our coordinator, with a follow up until March 1, 2024. Data were also compared with historical candidates’ workup evaluated at our program before January 1, 2021.

Results

101 candidate’s files were reviewed [Mean age 55.4±13.1 years, female (42.6%), Caucasian (76.2%)]. By March 1, 2024, 86.1% of candidates were on dialysis, with 79.3% of those on dialysis by the time of assessment. 78 (77.2%) candidates received a transplant decision while 23 patients stayed in workup, including 5 candidates who were referred, after completing their workup, to another center for combined organ transplantation. Median time from assessment to transplant decision was significantly shorter with more regular pre-transplant chart review at 12.8 (7.2-20.4) months, compared with historical candidates’ workup of 23.3 (14.3-37.1) months (P <0.001). At the time of transplant decision, 64 (63.4%) patients were on dialysis (12 on dialysis <1 year). Median time from dialysis to transplant decision was 24.1 (12.3-43.2) months, compared with historical candidates’ time of 31.6 (5.9-52.4) months (P 0.89). Dialysis vintage can be reduced further with earlier referral to transplant since median time from dialysis to initial assessment was longer in our cohort, 7.9 (2.9-32.1) months, compared with historical candidates’ time of 5.6 (-7.0-20.8) months (P 0.12).

Conclusion

Frequent and scheduled chart review of pre-transplant candidates results in shorter workup and dialysis vintage.