Transplant Readiness Assessment Clinic: A New Approach to Kidney Waitlist Management in the KAS Era.
1Div Nephrology, Stanford University, Palo Alto
2Kidney Transplant Program, Stanford University, Palo Alto, CA
Meeting: 2017 American Transplant Congress
Abstract number: 438
Keywords: Elderly patients, Kidney transplantation, Waiting lists
Session Information
Date: Tuesday, May 2, 2017
Session Name: Concurrent Session: Kidney Optimizing Donor/Recipient Selection and Matching
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: E450a
Kidney waitlist management has become increasingly complex in regions with long wait times. Increasing transplant options and the new Kidney Allocation System has added to burden of waitlist management, communication of waitlist status, and patient education. We have developed a new clinic and clinical flow for assessing transplant readiness. Here we report the outcomes of this pilot clinic.
Over 1800 patients are on our center's transplant wait list. Patients with Kidney Allocation Scores (KAS) 6 or greater were reviewed and were scheduled for Transplant Readiness Assessment Clinic (TRAC) for an updated assessment as needed. Of the 112 patients reviewed as part of the TRAC workflow, 21 (19%) were no longer considered eligible and removed from the transplant waitlist. Of the remaining 91 patients: 17 (19%) received transplants within a median of 95 days (range 23-182); 20 (22%) were activated; 54 (60%) required further medical testing or psychosocial support for activation.
| Baseline Characteristics and Outcomes Median (Quartile 1-3) | Transplanted | Removed | Waiting | Require Further Testing |
| Top-of-List Candidates | N=17 | N=21 | N=20 | N=54 |
| Age (year) | 57 (49-64) | 70 (49-75) | 51 (42-57) | 57 (45-67) |
| Sex (% female) | 53% | 48% | 35% | 46% |
| KAS | 15 (9-24) | 9 (8-12) | 10 (9-14) | 11 (9-94) |
| Group 1 (KAS>50) | 18% | 14% | 15% | 29% |
| Time to Activation (days) | 18 (1-73) | na | 73 (42-113) | na |
| Time to Transplant (days) | 95 (82-133) | na | na | na |
| Candidates Seen in TRAC Clinic | N=5 | N=7 | N=5 | N=13 |
| Age (year) | 62 (57-67) | 72 (57-75) | 60 (51-71) | 62 (58-68) |
| Sex (% female) | 40% | 43% | 40% | 54% |
| KAS | 14 (9-18) | 10 (9-109) | 9 (8-9) | 12 (7-57) |
| Group 1 (KAS>50) | 0% | 29% | 20% | 31% |
| Time to Activation (days) | 72 (58-76) | na | 44 (39-80) | na |
| Time to Transplantation (days) | 94 (82-133) | na | na | na |
A new pre-transplant clinic has been designed for re-evaluation of patients with high KAS. Of those transplanted, median time from review to organ offer and transplantation were 93 and 95 days. This new clinic flow may serve as a model for pre-transplant re-evaluation.
CITATION INFORMATION: Cheng X, Lee J, Tulu Z, Tan J. Transplant Readiness Assessment Clinic: A New Approach to Kidney Waitlist Management in the KAS Era. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Cheng X, Lee J, Tulu Z, Tan J. Transplant Readiness Assessment Clinic: A New Approach to Kidney Waitlist Management in the KAS Era. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-readiness-assessment-clinic-a-new-approach-to-kidney-waitlist-management-in-the-kas-era/. Accessed August 10, 2020.« Back to 2017 American Transplant Congress