A new study indicates that many Americans who might benefit the most from a kidney transplant may be missing out on a critical window of opportunity.
Several Preferred Patients Are Not Able To Get On Kidney Transplant List
The study focused on individuals with renal failure who were projected to live for several years after getting a kidney transplant. This typically comprises persons who are quite young and do not have any other severe medical issues.
The United States’ kidney allocation system changed in 2014 to assist guarantee that those patients receive a donor kidney that is expected to function for many years — generally from a young, healthy donor.
The expected post-transplant survival (EPTS) score was established as a grading system. Once on the waitlist, transplant candidates are assigned an EPTS score; individuals in the “top 20%” receive precedence if a very high-quality kidney becomes available.
The latest study, however, discovered that many patients who would fall into that group are not getting on the transplant waitlist on time.
Fewer than half of the more than 42,000 patients in the United States who would have scored in the top 20% were on the waitlist. And, of the 34,000 or so people who had started dialysis, just 37% were waiting for a transplant within three years.
It’s incredibly depressing, according to study leader Jesse Schold, an Ohio-based researcher at the Cleveland Clinic.
According to him, these are people who are extremely likely to perform well following a transplant. However, many will no longer have a high EPTS score by the time they are placed on the transplant waiting list.
Schold’s team discovered that 61 percent of dialysis patients dropped out of the top 20% category after 30 months. There were also inequalities, as found across U.S. health care: black patients and those from low-income groups were less likely to be waitlisted.
The results were published online in the Journal of the American Society of Nephrology on June 17th.
For most patients with end-stage renal disease or kidney failure, a kidney transplant is the best option. According to the United Network for Organ Sharing (UNOS), the charity that oversees the nation’s donor organ system, more than 90,000 Americans are now on the donor-kidney queue.
According to Dr. Joseph Vassalotti, chief medical officer of the nonprofit National Kidney Foundation, it’s much preferable to be recommended for a transplant before individuals require dialysis; a practice is known as proactive waitlisting. Unfortunately, this does not happen frequently enough.
The present research, he said, looked at patients who would be ideal transplant candidates, all with EPTS scores in the top 20% and an average age of 38.
According to Vassalotti, they should have a high proportion of placement on the waitlist.
Nonetheless, only around 7,900 of the 42,445 individuals were preemptively waitlisted. The remainder, more than 34,500 people, began dialysis between 2015 and 2017, with just 37% moving onto the transplant queue within three years.
Ideally, the issue should be handled well upstream, according to Schold, which means that more Americans with renal illness should have access to optimal care long before their kidneys fail.
According to Vassalotti, racial and income disparities in waitlisting may be related to a lack of access to specialized kidney (nephrology) care, whether it’s because primary care doctors aren’t referring patients, patients can’t afford it, or there aren’t enough specialists in patients’ communities.
However, Vassalotti also stated that doctors must do a better job of explaining the benefits and dangers of transplant over dialysis. And those talks, he believes, should take place early on so that people are empowered to prepare for what they want as their condition develops.
According to Darren Stewart, a chief research scientist at UNOS, the EPTS score has helped better match transplant patients with donor’s kidneys.
However, Stewart believes that this study shows the discrepancies in access to the waitlist in the first place.
He stated that UNOS lacks the authority to enact regulations about what happens before patients are waitlisted. However, he acknowledged that greater access to nephrology treatment, as well as better patient information regarding transplants, are required.
