Access to kidney transplantation: outcomes of the non-referred.
BACKGROUND
There is a concern that some, especially older people, are not referred and could benefit from transplantation.


METHODS
We retrospectively examined consecutive incident end stage renal disease (ESRD) patients at our center from January 2006 to December 2009. At ESRD start, patients were classified into those with or without contraindications using Canadian eligibility criteria. Based on referral for transplantation, patients were grouped as CANDIDATE (no contraindication and referred), NEITHER (no contraindication and not referred) and CONTRAINDICATION. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden.


RESULTS
Of the 437 patients, 133 (30.4%) were CANDIDATE (mean age 50 and CCI 3.0), 59 (13.5%) were NEITHER (age 76 and CCI 4.4), and 245 (56.1%) were CONTRAINDICATION (age 65 and CCI 5.5). Age was the best discriminator between NEITHER and CANDIDATES (c-statistic 0.96, P <0.0001) with CCI being less discriminative (0.692, P <0.001). CANDIDATES had excellent survival whereas those patients designated NEITHER and CONTRAINDICATION had high mortality rates. NEITHER patients died or developed a contraindication at very high rates. By 1.5 years 50% of the NEITHER patients were no longer eligible for a transplant.


CONCLUSIONS
There exists a relatively small population of incident patients not referred who have no contraindications. These are older patients with significant comorbidity who have a small window of opportunity for kidney transplantation.
Department of Medicine, Dalhousie University, Halifax, NS, Canada 5820 University Avenue, Halifax, NS, B3H 1V8, Canada. bryce.kiberd@dal.ca.
Meteb M
MM
Albugami
Romuald
R
Panek
Steven
S
Soroka
Karthik
K
Tennankore
Bryce A
BA
Kiberd