Management of the kidney waiting list (WL) is an essential and dynamic aspect of the pretransplant process; however, it remains under-studied and underappreciated. The study purpose was to evaluate the effectiveness of a prospective initiative to critically screen our current kidney WL in order to more appropriately characterize inactive (status 7) patients (pts) in the setting of the new Kidney Allocation System (KAS). Methods: As a Performance Improvement initiative, our center critically re-examined our status 7 WL pts to determine their primary reasons for being “inactive” such as prohibitive body weight, unresolved financial or psychosocial factors, or other medical co-morbidities. We next formulated the following criteria to identify those pts already on dialysis who should be considered for WL removal: Inactive status for ≥5 years; Financially ineligible ≥2 years; Demonstrated weight gain or failure to lose weight for ≥2 years in obese patients; ≥3 or more “No Shows” for maintenance appointments; Inability to implement recommended corrective action plan for ≥1 year (e.g. cessation of substance abuse, improvement in compliance or functional status, identifying an adequate support system); Or inactive status for ≥2 years with additional disqualifying criteria. Results: On 11/1/14, we had a total of 436/716 (61%) pts who were status 7 on our WL. Weekly sessions were scheduled with attending surgeons to discuss any pts meeting the above criteria followed by discussion with the full Selection Committee for official WL removal. Over a 4 month period, 134 pts (31%) were removed from the inactive WL such that 302/590 (51%) of the subsequent total WL remained inactive. During this same period, we also reduced status 7 pts on the kidney-pancreas and pancreas WLs each by >50%. No change occurred in the total number of pts on active WLs (N=288) even though 47 transplants were performed during this time. Conclusions: In the new KAS, waiting time is primarily determined by dialysis duration; therefore, it is no longer necessary to keep ineligible pts on the inactive WL for preservation of waiting time. Implementing the above guidelines will allow us to direct efforts on evaluating new pts and facilitating their timely placement on the WL as well as limiting the inactive list to those pts who have realistic opportunities for placement on the active WL once remedial issues are addressed.

CITATION INFORMATION: Smith F, Sheehan C, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Stratta R. Managing the Kidney Waiting List: Pride and Prejudice. Am J Transplant. 2016;16 (suppl 3).

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