Subjective and quantitative assessment of patient fitness for cadaveric kidney transplantation: the "equity penalty"

Mark Thomas, G. Luxton, H.R. Moody, A.J. Woodroffe, H. Kulkarni, W. Lim, Frank Christiansen, G. Opelz

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background. Patient fitness at the time of organ allocation has an impact on graft survival equivalent to the effect of human leukocyte antigen (HLA) matching. The variation between institutions in assessment of fitness is not known, nor is the potential impact on mean graft survival of incorporating patient fitness into local adult cadaveric-kidney transplant-allocation algorithms.Methods. Data from the Collaborative Transplant Study (CTS, 1985-2000) were reviewed. Quantitative criteria (QC) of patient fitness based on national transplant society guidelines were compared with subjective categorization (SC) of each patient on the current local transplant waiting list (n=109) determined by their supervising nephrologist.Results. Five-year cadaveric graft survival was 70%, 61%, and 53% for good-, moderate-, and poor-risk patients in the CTS data set (n=102, 612), equivalent to half lives of 12.7, 9.8, and 8.7 years, respectively, with similar results from the local program. The distribution of local waiting-list patients into fitness categories A (good), B (moderate), C (poor), and D (unacceptable) was 51%:31%:13%:5% by SC and 25%:40%:27%:8% by QC. At one hospital, 61% (n=51) of patients were classified category A by SC, and falling to 16% by QC (P
Original languageEnglish
Pages (from-to)1026-1029
JournalTransplantation
Volume75
Issue number7
Publication statusPublished - 2003

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