Palliative Care for the Patients with Failing Kidney Allograft: Kraft Survey
1Brigham and Women's Hospital, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA, 3University of Texas Austin, Austin, TX, 4Icahn School of Mount Sinai, New York, NY, 5Universiy of Alabama at Birmingham, Birmingham, AL, 6Vanderbilt University Medical Center, Nashville, TN, 7John C. McDonald Regional Transplant Center, Shreveport, LA, 8Washington University in St Louis, Chesterfield, MO, 9Medical University of South Carolina, Lancaster, SC, 10Weil Cornell Medicine, New York, NY, 11Weill Cornell Medicine - NYPH, New York, NY, 12Saint Louis University, St. Louis, MO, 13Washington University School of Medicine at St. Louis, Saint Louis, MO
Meeting: 2022 American Transplant Congress
Abstract number: 1365
Keywords: Graft failure, Kidney transplantation, Psychosocial, Quality of life
Topic: Clinical Science » Kidney » 33 - Kidney Psychosocial
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Care of patients with failing kidney allograft can be challenging with discordant expectations between clinicians and patients. These patients often suffer from multiple morbidities, are often frail and have high mortality. Re-transplantation or dialysis may not be an option for many such patients.
*Methods: To understand transplant clinicians’ attitudes around PC, and the barriers and facilitators in engaging PC for kidney transplant patients with failing allograft (eGFR<20 ml/min), we conducted an online survey through AST Hubs and eNews, targeting transplant clinicians in the US.
*Results: Total 84 participants (41 nephrologists, 26 RNs, 7 advanced practice providers, 4 social workers, 3 surgeons, 3 others) completed the survey. More than 80% of clinicians have never or rarely referred transplant patients to inpatient or outpatient PC, but they more frequently consider referral to mental health (66%). When considering a referral to PC, the patients’ poor functional status (86%), cancer diagnosis (76%) and frailty (74%) are the most reported important factors. For the timing of referral to PC, many providers disagreed with PC referral in pre-transplant (63%) or early post-transplant (69%) phases; however, most agree with referral at the time of chronic allograft dysfunction (59%), re-initiation of dialysis (63%) and end-of life (98%). In relation to transplant team skills, most felt comfortable managing symptoms (63%) and defining goals of care (59%), but not managing end-of-life care (30.5%). 41% thought that the goals of transplantation and PC are contradictory. 61% agreed with consulting PC only near end-of-life, but 64% also thought that early PC intervention may be beneficial if allograft dysfunction is persistent. Clinicians felt the management of allograft failure is most challenging when time course is uncertain (70%), and in patients ineligible for re-transplantation (82%) and with complex psychosocial situations (66%). Barriers to engaging PC include unrealistic patient/caregiver prognostic expectations (71%) and competing demands for clinicians’ time (51%).
*Conclusions: PC is underutilized in kidney transplant patients with failing allografts, and the survey highlighted the transplant clinicians’ hesitancy for PC referral.
To cite this abstract in AMA style:
Murakami N, Gelfand S, Reich AJ, Leiter R, Lakin J, Adler JT, Lu E, Ong S, Concepcion BP, Singh N, Murad H, Anand P, Ramer S, Dadhania D, Lentine K, Alhamad T. Palliative Care for the Patients with Failing Kidney Allograft: Kraft Survey [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/palliative-care-for-the-patients-with-failing-kidney-allograft-kraft-survey/. Accessed May 6, 2025.« Back to 2022 American Transplant Congress