Inactivity on the kidney transplant wait-list is associated with inferior pre- and post-transplant outcomes.
BACKGROUND
The majority of kidney transplant (KT) candidates spend some time on the transplant wait-list (WL) prior to kidney transplantation. We examined the impact of WL inactivity on clinical outcomes.


METHODS
All adult KT candidates first actively wait-listed between January 1, 1996, and December 31, 2005, in the United States were grouped by frequency of inactivity on the WL. Transplantation rate, pre- and post-transplant patient survival and death-censored kidney graft survival were compared.


RESULTS
Of 159,774 candidates who were placed on the WL, 48,598 (30.4%) experienced one or more periods of inactivity. Candidates with inactivity once or more on the WL had 42% and 27% less likelihood of KT, respectively (HR 0.58, 95% CI 0.57, 0.59 and HR 0.73, 95% CI 0.71, 0.75). WL inactivity once or more was associated with a higher likelihood of death (HR 1.94, 95% CI 1.88, 2.00 and HR 2.13, 95% CI 2.02, 2.24). Among KT recipients, inactivity more than once on the WL was associated with a higher risk of death (HR 1.14, 95% CI 1.05, 1.23).


CONCLUSIONS
Periods of inactivity on the WL predict increased mortality pre- and post-transplantation. A better understanding of the reasons for WL inactivity is essential to improve WL management and post-transplant outcomes.
Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. spnorman@med.umich.edu
Silas Prescod
SP
Norman
Mallika
M
Kommareddi
Fu Lung
FL
Luan
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists
inactivity; kidney; survival; transplant; wait-list