title: Barriers to preemptive renal transplantation: a single center questionnaire study.
abstract: BACKGROUND
  Preemptive transplantation results in excellent patient and graft survival yet most transplant candidates are referred for transplantation after initiation of dialysis. The goal of this study was to determine barriers to preemptive renal transplantation.
  
  
  METHODS
  A nonvalidated questionnaire was administered to prospective kidney transplant recipients to determine factors that hindered or favored referral for transplantation before the initiation of dialysis.
  
  
  RESULTS
  One hundred ninety-seven subjects referred for a primary renal transplant completed the questionnaire. Ninety-one subjects (46%) had been informed of preemptive transplantation before referral, and 80 (41%) were predialysis at the time of evaluation. The median time from diagnosis of renal disease to referral was 60 months (range, 2-444 months). In bivariate analysis, among other factors, knowledge of preemptive transplantation was highly associated (odds ratio=94.69) with referral before initiation of dialysis. Given the strong association between knowledge of preemptive transplantation and predialysis referral, this variable was not included in the multivariate analysis. Using multivariate logistic regression analysis, white recipient race, referral by a transplant nephrologist, recipient employment, and the diagnosis of polycystic kidney disease were significantly associated with presentation to the pretransplant clinic before initiation of dialysis.
  
  
  CONCLUSIONS
  The principle barrier to renal transplantation referral before dialysis was patient education regarding the option of preemptive transplantation. Factors significantly associated with referral before dialysis were the diagnosis of polycystic kidney disease, white recipient race, referral by a transplant nephrologist, and employed status. Greater effort should be applied to patient education regarding preemptive transplantation early after the diagnosis of end-stage renal disease.
authors.affiliation: 1 Department of Surgery, Houston Methodist Hospital, Houston, TX. 2 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX. 3 Department of Pharmacy, Houston Methodist Hospital, Houston, TX.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Knight
authors.forename: Larry D
authors.initials: LD
authors.lastname: Teeter
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
authors.forename: Samir J
authors.initials: SJ
authors.lastname: Patel
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: DeVos
authors.forename: Linda W
authors.initials: LW
authors.lastname: Moore
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D007690:Polycystic Kidney Diseases / Q000150:complications / Q000628:therapy; D012017:Referral and Consultation; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D013997:Time Factors