Prior Living Kidney Donors With ESRD May Not Get Timely Transplants
Some donors spend years on dialysis before being placed on the kidney transplant waiting list.
Despite receiving high priority on the kidney transplant waiting list, many prior living kidney donors in whom end-stage renal disease develops spend months or years on dialysis before being placed on the list, researchers reported at the 2016 American Transplant Congress in Boston.
Jennifer L. Wainright, PhD, and colleagues at the United Network for Organ Sharing in Richmond, VA, identified 210 prior living donors (221 registrations) with end-stage renal disease who were added to the waiting list from January 1, 2010 to July 31, 2015. As of September 4, 2015, 168 were removed from the waiting list because they received a deceased-donor transplant. Two patients died, 5 were too sick for transplantation, and 29 were still waiting for a transplant.
Of the 221 PLD registrations 90 (40.7%) were listed pre-emptively, with 6 patients beginning dialysis between listing and transplantation. Among the remaining 131 registrations, the median time between starting chronic dialysis and listing was 338 days. Results showed that 6.8% of PLDs were listed within 3 months of starting dialysis, 25.3% within 3 to 12 months, 12.2% within 1 to 2 years, and 14.9% more than 2 years after dialysis initiation.
The median time waiting in active status before receiving PLD priority was 2 days. Data revealed that 67.4% of PLDs received PLD priority within 7 days of activation, whereas 15.3% waiting 8 to 30 days, 8.1% waited 31 to 90 days, 4.1% waiting 3 to 12 months, and 5% waited more than 1 year for PLD priority.
The median total time in inactive status was 3 days. Dr. Wainright's group found that 68.3% of PLDs were inactive for fewer than 90 days, 17.6% for 3 to 12 months, 8.6% for 1 to 2 years, and 5.4% for more than 2 years.
Of the 31 PLD registrations that were inactive for more than 1 year, 21 were due to incomplete work-up and the others were due to various reasons such as candidate choice, sickness, and insurance issues.
“After listing, most PDLs receive priority and active status in a timely manner, but a substantial number spend time in active status without PLD priority or a large amount of time in inactive status, which affects their access to timely [transplantation],” the investigators concluded in their study abstract.