*Purpose: While preemptive kidney transplant is associated with superior outcomes, timely referral remains a significant barrier. Peer feedback may help improve practice. Our hypothesis is incorporating education regarding the importance of preemptive transplant and individualized peer feedback to nephrologists regarding their own transplant referral patterns will result in increased referrals.

*Methods: With a view to increasing both general and pre-emptive end stage renal disease patient referrals to transplant, in October 2018 our academic nephrology group was given a structured one-hour presentation regarding criteria for patient referral and the benefits of preemptive referral. From April 2018 to October 2019, every six months during faculty meetings the nephrologists were presented individualized data regarding their referral patterns to transplant as compared to their colleagues within the division, with the plan of continuing to present this data publically biannually to the group to encourage transplant referrals.

*Results: From the time period of April 1, 2018 to October 1, 2018 as compared to October 1, 2018 to April 1, 2019, nephrology referrals to transplant increased by over 45%, from 35 patients pre-intervention to 51 patients post-intervention (p=0.05, Graph 1). Six of eight nephrologists significantly increased patient referrals. Preemptive referral rates went from 40% of overall referrals to over 60%, (p=0.06). During the same time period, transplant referrals from other nephrology groups in the area showed a 5% increase in overall referral number (p=0.06, Graph 2). In the next six-month period from April 1, 2019 to October 1, 2019 nephrology referrals in our academic nephrology group continued to increase by over 29% to 66, maintaining over 60% preemptive.

*Conclusions: In this pilot project we used a cost effective educational session and individualized peer feedback to improve referrals to transplant. By sharing results relative to peers we created social affirmation and competition between members of the nephrology division that may have contributed to increased referrals. Our results suggest a generalizable and effective approach to increase both total and pre-emptive transplant referrals.

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