The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center

Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions. Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identi...

Full description

Saved in:
Bibliographic Details
Main Authors: Beatrice P. Concepcion, Rachel C. Forbes, Aihua Bian, Heidi M. Schaefer
Format: Article
Language:English
Published: Wiley 2016-01-01
Series:Journal of Transplantation
Online Access:http://dx.doi.org/10.1155/2016/7405930
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1832563569901699072
author Beatrice P. Concepcion
Rachel C. Forbes
Aihua Bian
Heidi M. Schaefer
author_facet Beatrice P. Concepcion
Rachel C. Forbes
Aihua Bian
Heidi M. Schaefer
author_sort Beatrice P. Concepcion
collection DOAJ
description Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions. Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status. Results. 345 patients were included in the statistical analysis. 31.6% of patients were turned down: 44% due to coronary artery disease (CAD), peripheral vascular disease (PVD), or both. After adjustment for patient demographics and comorbid conditions, history of CAD, PVD, or both (OR = 1.75, 95% CI (1.20, 2.56), p=0.004), chronic obstructive pulmonary disease (OR = 8.75, 95% CI (2.81, 27.20), p=0.0002), and cancer (OR 2.59, 95% CI (1.18, 5.67), p=0.02) were associated with a higher risk of being turned down. 14.8% of patients underwent unnecessary basic testing and 9.6% underwent unnecessary supplementary testing with the charges over a 3-year period estimated at $304,337. Conclusion. A significant number of older candidates are deemed unacceptable for kidney transplantation with primary reasons cited as CAD and PVD. The overall burden of unnecessary testing is substantial and potentially avoidable.
format Article
id doaj-art-812e821ba968402ba1b7e125a1b07257
institution Kabale University
issn 2090-0007
2090-0015
language English
publishDate 2016-01-01
publisher Wiley
record_format Article
series Journal of Transplantation
spelling doaj-art-812e821ba968402ba1b7e125a1b072572025-02-03T01:13:11ZengWileyJournal of Transplantation2090-00072090-00152016-01-01201610.1155/2016/74059307405930The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single CenterBeatrice P. Concepcion0Rachel C. Forbes1Aihua Bian2Heidi M. Schaefer3Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USAVanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN 37232, USADepartment of Biostatistics, Vanderbilt School of Medicine, Nashville, TN 37232, USADepartment of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USABackground. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions. Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status. Results. 345 patients were included in the statistical analysis. 31.6% of patients were turned down: 44% due to coronary artery disease (CAD), peripheral vascular disease (PVD), or both. After adjustment for patient demographics and comorbid conditions, history of CAD, PVD, or both (OR = 1.75, 95% CI (1.20, 2.56), p=0.004), chronic obstructive pulmonary disease (OR = 8.75, 95% CI (2.81, 27.20), p=0.0002), and cancer (OR 2.59, 95% CI (1.18, 5.67), p=0.02) were associated with a higher risk of being turned down. 14.8% of patients underwent unnecessary basic testing and 9.6% underwent unnecessary supplementary testing with the charges over a 3-year period estimated at $304,337. Conclusion. A significant number of older candidates are deemed unacceptable for kidney transplantation with primary reasons cited as CAD and PVD. The overall burden of unnecessary testing is substantial and potentially avoidable.http://dx.doi.org/10.1155/2016/7405930
spellingShingle Beatrice P. Concepcion
Rachel C. Forbes
Aihua Bian
Heidi M. Schaefer
The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
Journal of Transplantation
title The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
title_full The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
title_fullStr The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
title_full_unstemmed The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
title_short The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center
title_sort kidney transplant evaluation process in the elderly reasons for being turned down and opportunities to improve cost effectiveness in a single center
url http://dx.doi.org/10.1155/2016/7405930
work_keys_str_mv AT beatricepconcepcion thekidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT rachelcforbes thekidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT aihuabian thekidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT heidimschaefer thekidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT beatricepconcepcion kidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT rachelcforbes kidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT aihuabian kidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter
AT heidimschaefer kidneytransplantevaluationprocessintheelderlyreasonsforbeingturneddownandopportunitiestoimprovecosteffectivenessinasinglecenter