Background and Purpose: Transplantation is the best treatment for end-stage renal failure (ESRF). In Australia the algorithm for organ allocation considers a combination of factors including HLA matching, panel reactive antibody, blood group and time on dialysis. At present the deceased-donor list has an average waiting time of 3-5 years on dialysis with >1000 patients actively waiting. As a result there has been debate about the relevance of pursuing early wait-listing for transplantation when a living donor is not available. Some suggest that earlier listing prolongs time on the active waiting list without necessarily correlating to earlier transplantation. This study aimed to review the correlation between listing patients early after starting renal replacement therapy (RRT) and transplantation.

Methods: Patients commencing RRT between January 2012 and December 2014 were retrospectively analyzed. Patients were grouped according to whether they were listed at three months, six months or after six months. Patients were followed until the end of June 2015 (6-42 months post-RRT follow up). Outcomes in terms of living and deceased transplantation were measured. Sub-analysis focused on deceased donor transplants only.

Results: 183 patients were included in this study. By the end of the study period 109/183 (59.6%) patients were listed for transplantation. Of those 45/109 (41.2%) were listed by three months, 17/109 (15.5%) were listed between three and six months, and 47/109 (43.1%) were listed after six months. Of those listed 67/109 (61.5%) received a transplant by the end of the study period. 25/67 (37.3%) of those transplanted received a deceased donor organ. The median time to transplant was 1.06 years in those who were listed within six months and was 1.69 in those listed after six months.

Conclusions: Although time on dialysis is a factor in deceased organ allocation other factors allow some of the patients listed early to access deceased donor organs. Where possible living donation gives the highest chance of early transplantation. Early listing correlates with early transplantation, this gives superior outcomes for individual patients, however the population ethics of this require further analysis and discussion.

CITATION INFORMATION: Brown M, Polkinghorne K, Kanellis J. Optimal Measures for Timely Transplantation: Reviewing Correlation Between Early Transplantation Wait-Listing and Transplantation Outcomes. Am J Transplant. 2016;16 (suppl 3).

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