Introduction: Kidney transplant (KT) provides patients with improved survival rate and higher quality of life measures, and impose a significantly lower cost on Medicare when compared to their counterparts on dialysis. Moreover, seniors (≥ 65) have a higher mortality rate on dialysis. We hypothesized that seniors face different challenges to listing for KT compared to younger patients. We therefore performed a large retrospective single center study to examine the reasons for rule-outs in our institution, which lists patients only when their pre-transplant work-up is completed and they can be listed as ‘active’.

Methods: A retrospective medical record review of all adult patients evaluated for KT at Northwestern Memorial Hospital (NMH) between 1/2007 – 7/2012. Rule-out reasons were categorized. Dichotomized age (<65 versus ≥65 years) on reasons for rule out was examined by logistic regression and chi-square test.

Results: 3944 patients were evaluated for listing between 1/2007-7/2012 for KT and 934 were ruled out. Seniors were ruled out more frequently (OR=2.29); most often due to multiple comorbidities, outstanding testing (unable but compliant) and lack of physical/social support (p<0.05). Younger patients were most frequently ruled out due to high BMI (>45), non-compliance with testing (able but unwilling), and pursuit of KT at another center (p<0.05).

Discussion: The main reasons for rule-out to listing are different in seniors and younger patients. As seniors face lack of physical and social support and are often willing but unable to complete the preoperative testing, addressing these barriers might improve rates of listing and KT in seniors.

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