PDF(Pubmed)
Abstract：
BACKGROUND: Determining whether a patient is eligible for kidney transplantation is complex. In this study, we estimate what proportion of patients with end-stage kidney disease (ESKD) might have been suitable candidates for kidney transplantation but were not referred.
METHODS: We identified 43,952 people initiating dialysis for kidney failure between 2012 and 2017 in the states of Georgia, North Carolina, or South Carolina from the United States Renal Data System and linked to the Early-Steps to Transplant Access Registry to obtain data on referral and waitlisting up until December 2020. We identified \'good transplant candidates\' as those who were waitlisted within 2-years of referral, among all patients referred within 1-year of dialysis initiation. Using propensity score cut-offs, logistic regression, and area under the curve (AUC), we then estimated the proportion of individuals who may have been good transplant candidates, but were not referred.
RESULTS: Overall, 42.6% of incident dialysis patients were referred within one year and among them, 32.9% were waitlisted within 2 years of referral. Our model had reasonably good discrimination for identifying good transplant candidates with an AUC of 0.70 (95%CI 0.69-0.71), sensitivity of 0.68 and specificity of 0.61. Overall, 25% of individuals not referred for transplant may have been \'good\' transplant candidates. Adding these patients to the existing 18,725 referred patients would increase the proportion of incident ESKD patients being referred within one year from 42.6% to 57.2% (a ~ 14.6% increase).
CONCLUSIONS: In this study, we show that a significant proportion of potentially good transplant candidates are not being referred for transplant. A ~ 14% increase in the proportion of patients being referred from dialysis facilities is both a meaningful and realistic goal and could lead to more qualified patients being referred and subsequently waitlisted for a lifesaving transplant.
METHODS: We identified 43,952 people initiating dialysis for kidney failure between 2012 and 2017 in the states of Georgia, North Carolina, or South Carolina from the United States Renal Data System and linked to the Early-Steps to Transplant Access Registry to obtain data on referral and waitlisting up until December 2020. We identified \'good transplant candidates\' as those who were waitlisted within 2-years of referral, among all patients referred within 1-year of dialysis initiation. Using propensity score cut-offs, logistic regression, and area under the curve (AUC), we then estimated the proportion of individuals who may have been good transplant candidates, but were not referred.
RESULTS: Overall, 42.6% of incident dialysis patients were referred within one year and among them, 32.9% were waitlisted within 2 years of referral. Our model had reasonably good discrimination for identifying good transplant candidates with an AUC of 0.70 (95%CI 0.69-0.71), sensitivity of 0.68 and specificity of 0.61. Overall, 25% of individuals not referred for transplant may have been \'good\' transplant candidates. Adding these patients to the existing 18,725 referred patients would increase the proportion of incident ESKD patients being referred within one year from 42.6% to 57.2% (a ~ 14.6% increase).
CONCLUSIONS: In this study, we show that a significant proportion of potentially good transplant candidates are not being referred for transplant. A ~ 14% increase in the proportion of patients being referred from dialysis facilities is both a meaningful and realistic goal and could lead to more qualified patients being referred and subsequently waitlisted for a lifesaving transplant.
摘要：
背景：确定患者是否符合肾移植的条件是复杂的。在这项研究中,我们估计有多少终末期肾病(ESKD)患者可能是肾移植的合适候选人,但未转诊.
方法：我们在2012年至2017年期间，在佐治亚州确定了43,952名开始肾衰竭透析的人。北卡罗来纳州,或来自美国肾脏数据系统的南卡罗来纳州，并与移植访问登记处的早期步骤相关联，以获取截至2020年12月的转诊和等待列表数据。我们确定了“良好的移植候选人”，即在转诊后的2年内被列入候补名单的人，在开始透析1年内转诊的所有患者中.使用倾向得分截止值，逻辑回归，和曲线下面积（AUC），然后我们估计了可能是好的移植候选人的比例，但没有被提及。
结果：总体而言，42.6%的透析患者在一年内转诊，其中，32.9%在转诊后2年内被列入候补名单。我们的模型在识别AUC为0.70（95CI0.69-0.71）的良好移植候选者方面具有相当好的辨别力，敏感性为0.68，特异性为0.61。总的来说,25%的未接受移植的个体可能是“良好的”移植候选人。将这些患者添加到现有的18,725名转诊患者中，一年内转诊的ESKD患者比例将从42.6％增加到57.2％（约增加14.6％）。
结论：在这项研究中，我们发现,相当大比例的潜在良好移植候选人没有被转诊进行移植.从透析设施转诊的患者比例增加约14％是一个有意义且现实的目标，并且可能导致更多合格的患者被转诊并随后等待进行挽救生命的移植。
方法：我们在2012年至2017年期间，在佐治亚州确定了43,952名开始肾衰竭透析的人。北卡罗来纳州,或来自美国肾脏数据系统的南卡罗来纳州，并与移植访问登记处的早期步骤相关联，以获取截至2020年12月的转诊和等待列表数据。我们确定了“良好的移植候选人”，即在转诊后的2年内被列入候补名单的人，在开始透析1年内转诊的所有患者中.使用倾向得分截止值，逻辑回归，和曲线下面积（AUC），然后我们估计了可能是好的移植候选人的比例，但没有被提及。
结果：总体而言，42.6%的透析患者在一年内转诊，其中，32.9%在转诊后2年内被列入候补名单。我们的模型在识别AUC为0.70（95CI0.69-0.71）的良好移植候选者方面具有相当好的辨别力，敏感性为0.68，特异性为0.61。总的来说,25%的未接受移植的个体可能是“良好的”移植候选人。将这些患者添加到现有的18,725名转诊患者中，一年内转诊的ESKD患者比例将从42.6％增加到57.2％（约增加14.6％）。
结论：在这项研究中，我们发现,相当大比例的潜在良好移植候选人没有被转诊进行移植.从透析设施转诊的患者比例增加约14％是一个有意义且现实的目标，并且可能导致更多合格的患者被转诊并随后等待进行挽救生命的移植。
