A comparison of persons who present for preemptive and nonpreemptive kidney transplantation.

BACKGROUND: Preemptive renal transplantation (PRT) has been associated with improved allograft and patient survival rates and requires that the medical evaluation for suitability for transplantation occurs before the initiation of maintenance dialysis. The aim of this study was to understand the factors associated with the timing of evaluation for renal transplantation relative to the initiation of dialysis.

METHODS: In a prospective study, patients who presented to the Renal Transplant Evaluation Clinic at the Hospital of the University of Pennsylvania completed a self-administered questionnaire.

RESULTS: Of the 290 patients included in the analysis, 44.5% were not yet on dialysis. Non-dialysis-dependent persons had seen a nephrologist for a mean of 71.0 +/- 84.7 months before transplant evaluation, whereas persons who presented for nonpreemptive evaluation reported first seeing a nephrologist a mean of 25.0 +/- 42.8 months before dialysis initiation (P < 0.001). First learning about transplantation from somebody other than a nephrologist significantly increased the odds of undergoing nonpreemptive transplant evaluation (adjusted odds ratio [OR], 2.46; P = 0.01). The odds of nonpreemptive evaluation were decreased for every additional 3 months of chronic renal disease care by a nephrologist (adjusted OR, 0.96; P < 0.001) and significantly decreased if the patient reported having a spouse as a potential donor (adjusted OR, 0.41; P = 0.03).

CONCLUSION: There is substantial opportunity for transplant evaluation before dialysis initiation that is not capitalized on and is affected by the duration of care provided by a nephrologist and the type of potential living donor.