widespread acceptance that kidney transplants are the best
treatment for patients with end-stage kidney disease, many of
these patients do not get transplants and are given long-term
into the possible reasons why, a study of Georgia’s three
transplant centers in a recent issue of the Journal of the
American Medical Association found only 28 percent of adult
patients starting dialysis were referred for kidney transplant
evaluation within a year, and there were a variety of
differences — in regard to race, socioeconomics and
geography — in referral rates among dialysis facilities.
don’t expect much difference in other parts of the
country," said Kalathil K. Sureshkumar, medical director
of the kidney and pancreas transplant program at Pittsburgh’s
Allegheny General Hospital. He added that this may be one of
the first studies on the topic. "It’s a lot about
educating the patient … maybe they’re not wholly aware of
Sureshkumar explained that a referral is the first step for
patients to get a transplant: At the transplant center, they
would be evaluated to see if they are a good candidate for a
new kidney, and ultimately they would be put on a waiting list
for a transplant.
transplant, he said, "It turns out to be cheaper than
keeping people on dialysis. And they have a better quality of
life, a longer life."
the need for kidney donations and various disparities continue
to block access to a transplant for many.
Georgia study analyzed the cases of a group of 15,279
patients, ages 18-69, at 308 Georgia dialysis facilities.
the findings were: Facilities with the lowest likelihood of
referral for a transplant within one year of starting dialysis
were more likely to be nonprofit, hospital-based, have more
patients, treat patients in high-poverty neighborhoods and
have a higher ratio of patients for every social worker.
found referrals varied from zero percent to 75 percent in the
dialysis facilities. They concluded that prevailing methods of
gauging the quality of dialysis facilities — measuring the
length of time patients wait for a transplant and how well
they do after a kidney transplant — may not be good enough.
How long patients are "wait-listed" had racial
disparities, for example, but the referral rates didn’t.
reason for the findings were not clear, and the researchers
called for further study into how health policy could
alleviate disparities, how poorly performing dialysis centers
could be improved and what factors influence a patient’s
eligibility for a transplant at dialysis facilities and what
factors at transplant centers influence wait listing.
study also called for researchers to "continue to
develop, test and implement pragmatic interventions" to
improve an understanding among health care professionals and
patients of what a kidney transplant involves.
U.S., about 100,000 people are on a waitlist, Dr. Sureshkumar
said, but only about 16,000 kidneys are transplanted each
really want people to get transplants," he said, adding
that the best results come with "preemptive"
transplants, before a patient goes on dialysis.
happen when a patient with kidney disease is under the care of
a nephrologist, who can refer the patient for a transplant,
usually when kidney function is about 15 percent, he said.
they’re not going to improve, they’re eligible. People don’t
need dialysis before they are 10 percent or below."
times for a transplant can be three to four years in
Pittsburgh, he said. "In New York, it’s six or seven
years; it’s longer in California."
transplants do the best long-term. The kidney function lasts
the longest. (In contrast) the longer you stay on dialysis,
the outcomes after a transplant are worse than if you were
never on dialysis."
on the recent study, he said, "Maybe we need more
guidelines to make sure staff and patients make the most of