Background: Potential kidney transplant (KT) candidates may obtain differing opinions on their transplant candidacy depending on where they are evaluated. Little is known on outcomes among patients who seek second opinions after denial for KT listing.

Methods: We performed a retrospective cohort study of all adults (age> 18 years) evaluated for KT at our center between July 1, 2015 and June 30, 2016. The primary exposure was previous denial for KT listing, ascertained by self-report and medical records. We fit logistic regression models to examine the association of previous denial on the following: 1) denial for listing at 12 months, and 2) active listing at 12 months.

Results: Among 196 new KT evaluations, 27% (n=52) reported being previously denied access to the waiting list. Reasons for previous denial included medical comorbidities (29%), failure to complete evaluation (19%), and psychosocial factors (12%). Compared to those who were not previously denied listing, more of those who were previously denied were already on dialysis (92% vs 72%, p=0.003) and had public insurance (83% vs 57%, p=0.002). Other key demographics/characteristics were similar between the groups. At 12 months, 35% of the cohort (n=68) had been denied listing

and 37% (n=72) had achieved active listing. In multivariable logistic regression adjusted for age, race, sex, obesity, education level, dialysis, and insurance, previous denial was not independently associated with current denial (adjusted odds ratio [aOR] among previously denied 0.94, 95% CI 0.45-1.97). Previous denial was independently associated with a higher odds of active listing at 12 months (aOR among previously denied 2.74, 95% CI 1.26-5.81).

Conclusion: In this single center study, a large proportion of patients evaluated for KT had been previously denied access to the waiting list. Compared to those who were not previously denied, patients with previous denial were not at increased risk of denial on repeat evaluation, and were more likely to be activated on the waiting list by 12 months. Future studies are needed to examine the impacts of variability in transplant center acceptance criteria on access to KT.

CITATION INFORMATION: Harhay M., Bajakian T., Ranganna K., Malat G., Guy S., Xiao G., Levin Mizrahi L., Reich D. Outcomes of Second Opinion Kidney Transplant Evaluations Am J Transplant. 2017;17 (suppl 3).

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