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Kidney Transplant Listings Have Increased in Patients With Prior Non-kidney Transplants
These are the findings of a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results indicate that the growth in the numbers of this group of kidney transplant candidates adds to the list of organ allocation challenges.
Kidney failure may accompany or complicate transplantation of the liver, heart, or lung. Because increasing numbers of individuals are receiving non-kidney transplants, researchers have wondered whether more of such patients are being listed for kidney transplants.
Titte Srinivas, MD (Cleveland Clinic) and his colleagues examined data from 1995 to 2008 from the national SRTR (Scientific Registry of Renal Transplant Recipients), and found a total of 4904 individuals who had had a prior organ transplant were waitlisted to receive a kidney transplant during this time period. Prior to 1995, less than 1% of people who had received other organ transplants were placed on kidney transplant waiting lists; in 2008, 3.3% of those who had received other organ transplants were waitlisted for kidney transplants.
The researchers found among individuals who had a prior organ transplant, 38% were waitlisted to receive a kidney transplant before initiating dialysis, compared with 21% of individuals who had not received a prior organ transplant. "Pre-emptive transplantation of a kidney (prior to dialysis) and listing for such is the preferred modality of management of end-stage kidney disease. This modality is especially relevant in the non-renal transplant population as they have much higher waitlist mortality than those with prior renal transplants. However, the more frequent pre-emptive transplants occurring in these patients may be a product of these patients and their caregivers being more familiar with navigating transplant procedures, and thus receiving superior pre-transplant care" said Dr. Srinivas. The impact of how physician advocacy plays a role needs investigation as well.
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