Rates of completion of the medical evaluation for renal transplantation.
BACKGROUND
Failure to complete the medical evaluation for renal transplantation may impede access to transplantation and preclude the possibility of preemptive transplantation. We sought to (1) characterize completion rates of the transplantation medical evaluation and (2) determine factors associated with completion of the evaluation. We hypothesized that patients not on dialysis therapy complete the evaluation process more quickly than patients receiving dialysis.


METHODS
Between September 2002 and September 2003, a total of 175 patients who were evaluated for renal transplantation at the Hospital of the University of Pennsylvania were enrolled in a prospective cohort study. Patients completed a self-administered questionnaire. The progress of patients' medical evaluations, including completion of requested tests and evaluations, was extracted from the electronic medical record.


RESULTS
During follow-up, 100 patients (57.1%) completed the evaluation, including tests and evaluations requested by the transplant team, whereas 49 patients (28.0%) had tests still pending. The remaining patients died (2.3%), lost interest in transplantation (1.1%), or were immediately (7.4%) or later (4.0%) declared medically ineligible for transplantation. In the multivariable Cox proportional hazards model, black race (adjusted hazard ratio, 0.63; 95% confidence interval, 0.40 to 1.00; P = 0.05) was associated with time to completion of the transplantation evaluation, but receiving maintenance dialysis at the time of the initial transplantation evaluation was not (adjusted hazard ratio, 0.92; 95% confidence interval, 0.60 to 1.42; P = 0.72).


CONCLUSIONS
Completion of the medical evaluation for transplantation is slower in blacks than nonblacks. We were unable to detect a significant difference between dialysis and nondialysis patients in rates of completion of the evaluation.
Weng
Francis L
FL
Renal-Electrolyte and Hypertension Division, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. fweng@sbhcs.com
Joffe
Marshall M
MM
Feldman
Harold I
HI
Mange
Kevin C
KC
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018579:Patient Selection; D010414:Pennsylvania / Q000453:epidemiology; D011300:Preoperative Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists