To optimize the benefits of kidney transplantation, recipients and clinicians should have an agreed, shared management plan. This relies on prioritizing the same outcomes but patient experiences of transplantation and dialysis are likely to result in quite different preferences. As a sub study of the Standardised Outcomes in Nephrology (SONG) – Kidney Transplant initiative, the aim was to evaluate the relative importance of outcomes in kidney transplantation.

Participants completed a best-worst scaling survey to elicit the relative importance for 16 critical outcomes identified by stakeholder consensus. Each participant was randomly assigned to one of four blocks containing five lists, each with six of the outcomes and identified the most and the least important outcome from each list. Multinomial logistic regression models were used to calculate relative importance scores for each outcome normalized to the range 0 (least important) to 10 (most important).

In total, 395 (201 patients/caregivers, 194 health professionals) from 51 countries participated. Death was most important for health professionals (importance score 10.0 95% confidence intervals 8.5 to 11.5) compared to patients/caregivers where death was less important (5.1:4.4 to 5.0) and the same as chronic rejection (5.1:4.6 to 5.6) and graft loss (5.4:5.0 to 5.9) and similar to graft function (4.6:4.2 to 5.0) and acute rejection (4.5:4.1 to 4.9). Compared to health professionals, patients/caregivers placed greater importance on chronic and acute graft rejection, skin cancer, surgical complications and blood pressure, and less importance on hospitalization. The least important outcome for both health professionals and patients/caregivers was the ability to work with a preference score of zero.

Patients consider graft function, graft loss, and chronic and acute rejection to be as important as death, or more important, compared to health professionals. This focus on graft-centric outcomes may reflect a strong aversion to returning to dialysis and equating any graft dysfunction with graft loss. These findings also have implications in relation to communication strategies between health professionals and patients.

CITATION INFORMATION: Howell M, Evangelidis N, Sautenet B, Wong G, Craig J, Howard K, Tong A. Multi-Stakeholder Perspectives on the Importance of Outcomes for Trials in Kidney Transplantation: An International Best Worse Scaling Survey. Am J Transplant. 2017;17 (suppl 3).

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