The number of candidates on the list for kidney transplantation due to end-stage renal disease after a prior nonrenal transplant, particularly liver transplant, is growing significantly. This increasing trend raises important questions about equitable access to optimal medical care for renal transplant candidates.

In a retrospective study looking at the Scientific Registry of Transplant Recipients national database from 1988 to 2006, the percentage of kidney transplant candidates who were prior nonrenal transplant patients had grown from less than 1% in 1990 to 3.3% in 2006. Patients who had previously received a nonrenal transplant were put on the list to receive a kidney prior to dialysis initiation more frequently (36%) than kidney-alone patients (22%) and received organs of similar quality.

This discrepancy in rates of pre-emptive listing may indicate that former nonrenal transplant patients have disproportionately greater access to medical management by transplant surgeons. Such access has implications for the process of organ allocation in renal transplantation. These findings were presented at the 9th Annual State of the Art Winter Symposium of the American Society of Transplant Surgeons in Marco Island, Fla., by lead investigator Titte Srinivas, MD.

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It has been shown repeatedly that pre-emptive kidney transplantation has significant survival benefits over waiting for a kidney transplant on dialysis. However, more frequent pre-emptive transplantation in former nonrenal transplant recipients than in ESRD patients at large raises serious concerns.

The data suggest a disparity in access to optimal medical practices that enhance survival between these two patient groups. We believe it is important to formulate practices that can ensure fairness and equity in the allocation of resources for renal transplantation.