title: Preemptive renal transplant candidate survival, access to care, and renal function at listing.
abstract: BACKGROUND
  Preemptive transplantation is associated with better survival and transplant outcomes than transplantation after dialysis has been started. The purpose of this study is to examine associations between candidate characteristics, likelihood of preemptive transplant, candidate survival and renal function (RF) at the time of listing.
  
  
  METHODS
  We looked at 57 677 solitary renal transplant candidates from the Scientific Registry of Transplant Recipients database listed prior to dialysis from 2000 to 2009. Using multivariable models, we measured associations between candidate characteristics, likelihood of preemptive transplantation, candidate survival and RF at listing.
  
  
  RESULTS
  Candidates with higher RF at listing were more likely to be male, Caucasian, diabetic, be a prior transplant recipient and have more education. Higher RF at listing was strongly associated with greater likelihood of receipt of preemptive transplant [adjusted odds ratio = 1.45, 95% confidence interval (CI) 1.38-1.51] and conferred a significant survival advantage [adjusted hazards ratio = 0.84, 95% CI 0.79-0.89, per 5 mL/min/1.73 m(2)].
  
  
  CONCLUSIONS
  Patient characteristics associated with higher RF at listing suggest differences in access to care. Given that higher RF at the time of listing was also significantly associated with greater likelihood of preemptive transplantation and better survival prior to transplantation, our results suggest that listing at higher levels of RF may improve transplant candidate outcomes.
authors.affiliation: Glickman Urological/Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. rbfissell@yahoo.com
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Fissell
authors.forename: Titte
authors.initials: T
authors.lastname: Srinivas
authors.forename: Rich
authors.initials: R
authors.lastname: Fatica
authors.forename: Joseph
authors.initials: J
authors.lastname: Nally
authors.forename: Sankar
authors.initials: S
authors.lastname: Navaneethan
authors.forename: Emilio
authors.initials: E
authors.lastname: Poggio
authors.forename: David
authors.initials: D
authors.lastname: Goldfarb
authors.forename: Jesse
authors.initials: J
authors.lastname: Schold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D014481:United States; D014850:Waiting Lists; D055815:Young Adult