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Development and evaluation of dedicated low clearance transplant clinics for patients with failing kidney transplants
Author(s) -
Arshad Adam,
JacksonSpence Francesca,
Sharif Adnan
Publication year - 2019
Publication title -
journal of renal care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.381
H-Index - 27
eISSN - 1755-6686
pISSN - 1755-6678
DOI - 10.1111/jorc.12268
Subject(s) - medicine , kidney transplant , dialysis , kidney transplantation , cohort , kidney disease , retrospective cohort study , transplantation , renal transplant , surgery
SUMMARY Background Recipients with failing kidney transplants (RFKTs) may receive sub‐optimal care compared with patients with native kidney disease. The aim of this study is to compare the outcomes of RFKTs managed in a dedicated low clearance transplant clinic (LCTC) compared with those attending a general transplant clinic. Methods We undertook a retrospective analysis of patients with failing kidney transplants comparing two clinics—a LCTC versus a general transplant clinic. Kidney transplant recipients with an eGFR < 20 ml/min were included. A cross‐sectional analysis was undertaken of all patients with two consecutive follow‐up visits between the dates of January and July 2016 in either clinic, with follow‐up to event or December 2017. Results Data were analysed for 141 kidney transplant recipients; 60 in the LCTC and 81 in the general transplant clinic. More patients in the LCTC cohort were non‐white and early transplant recipients. A significantly greater proportion of LCTC versus general transplant patients had received documented discussions regarding their hepatitis vaccine status (63.3% vs. 17.3%, p < 0.001), counselled regarding dialysis modality (98.3% vs. 55.6%, p < 0.001) and had documented decision regarding re‐transplantation (80.0% vs. 58.0%, p = 0.006). No difference was noted in the comparison of any clinical or biochemical parameters. More patients seen in the LCTC lost their kidney allograft (HR: 2.09, 95%CI: 1.17–3.72, p = 0.013) but patient survival was equivalent (p = 0.343). Conclusion Our data suggest the management of RFKTs within LCTCs can focus attention on renal replacement therapy planning and counselling, but further work is warranted to investigate for any benefit in hard outcomes such as survival.