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Abstract

Context:

Given the aging end-stage renal disease (ESRD) population, kidney transplant (KTx) centers may experience an increase in referrals of patients living in long-term care (LTC) settings (eg, skilled nursing facilities, assisted living facilities, group homes, and boarding homes).

Objective:

To identify best practices among KTx professionals when considering individuals in LTC settings for transplantation.

Design and Setting:

A cross-sectional survey administered online to US transplant professionals via e-mail LISTSERVs and other professional networks.

Participants:

One hundred twenty-six KTx professionals working in the United States.

Main Outcome Measures:

The survey was composed of demographic questions and 6 hypothetical scenarios. These scenarios asked participants to assess transplant candidacy of patients with ESRD living in LTC settings based on the information provided in the scenario. Each scenario presented a different variable that necessitated LTC placement, including lack of social support, moderate intellectual disability, stable neurological condition, mild dementia, a psychiatric condition controlled on medications, and limited mobility.

Results:

The only scenario that elicited an overwhelmingly negative response was mild dementia with 73.9% of participants unwilling to consider such patients for KTx. By contrast, the proportion of KTx professionals reluctant to proceed with KTx in the remaining scenarios ranged between 40.0% and 50.6%.

Conclusions:

This survey of a large number of KTx professionals suggests that there is presently no best practice consensus regarding offering KTx to patients living in LTC settings. Further research should include a broader range of KTx professionals and should also include a study of outcomes with KTx in this particular patient population.

Keywords

kidney transplantation long-term care quality of life resource allocation older adults patient selection

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References

Wolfe

Ashby

Milford

. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–1730.

Laupacis

Keown

Pus

. A study of the quality of life and cost-utility of renal transplantation. Kidney Int. 1996;50(1):235–242.

Health Resources and Services Administration. Organ Procurement and Transplantation Network [Internet]. 2016. http://optn.transplant.hrsa.gov. Accessed November 4, 2016.

U.S. Census Bureau. 2012 Population Estimates and 2012 National Projections [Internet]. 2014. http://www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed September 29, 2016.

U.S. Renal Data System. USRDS 2015 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease; 2015.

Hart

Smith

Skeans

. OPTN/SRTR annual data report 2014: kidney. Am J Transplant. 2016;16(suppl 2):11–46.

U.S. Renal Data System. USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Disease and Digestive and Kidney Disease; 2004.

U.S. Renal Data System. USRDS 2010 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases; 2010.

Harris-Kojetin

Sengupta

Park-Lee

Valverde

. Long-term care services in the United States: 2013 overview. Vital Health Stat 3. 2013;(37):1–107.

10.

Health Resources and Services Administration. Organ Procurement and Transplantation Network: OPTN/UNOS Ethics Committee General Considerations in Assessment for Transplant Candidacy [Internet]. 2010. https://optn.transplant.hrsa.gov/resources/ethics/general-considerations-in-assessment-for-transplant-candidacy/. Accessed September 29, 2016.

11.

Bloom

Doyle

. Evaluation of the kidney transplant candidate and follow-up of the listed patient. In: McKay

Steinberg

, eds. Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients. New York, NY: Springer; 2010:191–206.

12.

Dobbels

De Geest

Cleemput

. Psychosocial and behavioral selection criteria for solid organ transplantation. Prog Transplant. 2001;11(2):121–132.

13.

Ramos

Kasiske

Alexander

. The evaluation of candidates for renal transplantation. The current practice of U.S. transplant centers. Transplantation. 1994;57(4):490–497.

14.

Levenson

Olbrisch

. Psychosocial evaluation of organ transplant candidates: a comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics. 1993;34(4):314–323.

15.

Kasiske

Ramos

Gaston

. The evaluation of renal transplant candidates: clinical practice guidelines. Patient Care and Education Committee of the American Society of Transplant Physicians. J Am Soc Nephrol. 1995;6(1):1–34.

16.

Spector

. Summated Rating Scale Construction: An Introduction. Newbury Park, CA: Sage; 1992.

17.

Hall

O’Hare

Anderson

Colón-Emeric

. End-stage renal disease in nursing homes: a systematic review. J Am Med Dir Assoc. 2013;14(4):242–247. doi:10.1016/j.jamda.2013.01.004.

18.

De Geest

Borgermans

Gemoets

. Incidence, determinants, and consequences of subclinical noncompliance with immunosuppressive therapy in renal transplant recipients. Transplantation. 1995;59(3):340–347.

19.

Humar

Denny

Matas

Najarian

. Graft and quality of life outcomes in older recipients of a kidney transplant. Exp Clin Transplant. 2003;1(2):69–72.

20.

Rakowski

Caillard

Agodoa

Abbott

. Dementia as a predictor of mortality in dialysis patients. Clin J Am Soc Nephrol. 2006;1(5):1000–1005.

21.

Kurella Tamura

O’Hare

McCulloch

Johansen

. Signs and symptoms associated with earlier dialysis initiation in nursing home residents. Am J Kidney Dis. 2010;56(6):1117–1126. doi:10.1053/j.ajkd.2010.08.017.

22.

Benedetti

Asolati

Dunn

. Kidney transplantation in recipients with mental retardation: clinical results in a single-center experience. Am J Kidney Dis. 1998;31(3):509–512.

23.

Martens

Jones

Reiss

. Organ transplantation, organ donation and mental retardation. Pediatr Transplant. 2006;10(6):658–664.

24.

Center for Disease Control and Prevention, Division of Diabetes Translation. United States Diabetes Surveillance System [Internet]. 2016. https://www.cdc.gov/diabetes/statistics/slides/maps_diabetesobesity94.pdf. Accessed October 2, 2016.

Transplant Professionals’ Perceptions of Long-Term Care Residents’ Candidacy for Kidney Transplantation