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Kianda MN, Wissing KM, Broeders NE, Lemy A, Ghisdal L, Hoang AD, Mikhalski D, Donckier V, Vereerstraeten P, Abramowicz D. Ineligibility for renal transplantation: prevalence, causes and survival in a consecutive cohort of 445 patients. Clin Transplant 2010; 25:576-83. [PMID: 20718825 DOI: 10.1111/j.1399-0012.2010.01317.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Little is known about the proportion of renal transplant candidates who are considered ineligible by the transplant center, the reasons of their ineligibility and their survival during dialysis. In this retrospective, single-center study of 445 adult patients referred between 2001 and 2006, 36 (8%) were deemed ineligible for medical contraindications. The leading reason was cardiovascular (CV) (75%), specifically aorto-iliac, and/or limb vessels atheromatosis or calcifications; ischemic heart disease; or a combination thereof. Nine patients had other contraindications that were absolute for three of them; six patients displayed a combination of relative contraindications. When compared to eligible patients (N = 409), those ineligible were significantly older (60 yr vs. 48), more often diabetics (50% vs. 15%), obese (39% vs. 17%) suffering from coronary artery disease (53% vs. 11%) and peripheral arterial disease (86% vs. 11%). Their primary nephropathy was more often diabetic and/or hypertensive/nephroangiosclerosis (61% vs. 23%), and their median dialysis vintage prior to evaluation was longer (29 months vs. 10, p < 0.0001). The actuarial survival of ineligible patients was significantly lower than that of eligible patients (at five yr: 53% vs. 88%). Adequate control of CV risk factors before dialysis and early referral for transplantation might help to improve eligibility of renal transplant candidates.
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Affiliation(s)
- Mireille N Kianda
- Renal Transplantation Clinic, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Bryce CL, Angus DC, Arnold RM, Chang CCH, Farrell MH, Manzarbeitia C, Marino IR, Roberts MS. Sociodemographic differences in early access to liver transplantation services. Am J Transplant 2009; 9:2092-101. [PMID: 19645706 PMCID: PMC2880404 DOI: 10.1111/j.1600-6143.2009.02737.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The question of whether health care inequities occur before patients with end-stage liver disease (ESLD) are waitlisted for transplantation has not previously been assessed. To determine the impact of gender, race and insurance on access to transplantation, we linked Pennsylvania sources of data regarding adult patients discharged from nongovernmental hospitals from 1994 to 2001. We followed the patients through 2003 and linked information to records from five centers responsible for 95% of liver transplants in Pennsylvania during this period. Using multinomial logistic regressions, we estimated probabilities that patients would undergo transplant evaluation, transplant waitlisting and transplantation itself. Of the 144,507 patients in the study, 4361 (3.0%) underwent transplant evaluation. Of those evaluated, 3071 (70.4%) were waitlisted. Of those waitlisted, 1537 (50.0%) received a transplant. Overall, 57,020 (39.5%) died during the study period. Patients were less likely to undergo evaluation, waitlisting and transplantation if they were women, black and lacked commercial insurance (p < 0.001 each). Differences were more pronounced for early stages (evaluation and listing) than for the transplantation stage (in which national oversight and review occur). For early management and treatment decisions of patients with ESLD to be better understood, more comprehensive data concerning referral and listing practices are needed.
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Affiliation(s)
- C. L. Bryce
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Section for Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, PA,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,Corresponding author: Cindy L. Bryce,
| | - D. C. Angus
- The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - R. M. Arnold
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - C.-C. H. Chang
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Section for Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, PA,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - M. H. Farrell
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - C. Manzarbeitia
- (former) Chair, Division of Transplant Surgery, Einstein Medical Center and Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - I. R. Marino
- Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
| | - M. S. Roberts
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Section for Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, PA,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA
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