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Waitlist Placement, Kidney Transplant Rates Not Improving

FRIDAY, Feb. 12, 2021 -- For patients with end-stage kidney disease (ESKD), there has been little improvement in the rates of waitlist placement or transplantation (WLT) since 1997, according to a study published online Feb. 11 in the Journal of the American Society of Nephrology.

Jesse D. Schold, Ph.D., from the Cleveland Clinic, and colleagues examined the longitudinal pattern of access to kidney transplantation among ESRD patients aged 18 to 70 years from 1997 to 2016 in the United States Renal Data System. Data were included for 1,309,998 patients.

The researchers found that the four-year WLT incidence was 29.7 percent, which was stable over five eras from 1997-2000 to 2013-2016. There was an increase seen in preemptive WLT (prior to dialysis) by era, from 5.2 percent in 1997 to 2000 to 9.8 percent in 2013 to 2016. Four-year WLT incidence increased among patients aged 60 to 70 years (13.4 to 19.8 percent) but decreased among patients aged 18 to 39 years (55.8 to 48.8 percent). Among patients in lower income communities, four-year WLT incidence was considerably lower, with no improvement over time. The investigators observed a significant decrease over time in the probability of WLT after dialysis (adjusted hazard ratio, 0.80 for 2013 to 2016 versus 1997 to 2000).

"These findings suggest that the cumulative efforts to improve access to transplantation have had minimal effect in the overall population and more effective strategies are needed," Schold said in a statement. "In addition, disparities in access to transplantation are striking and suggest that many factors beyond clinical risks and viability for the procedure impact patients' ability to receive a transplant."

Several authors disclosed financial ties to biotechnology and pharmaceutical companies.

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Posted: February 2021

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