24-Hour Crisis Hotline: (877)SAFEGBC or (877)723-3422 Mental Health & Substance Abuse Issues

6502 Nursery Drive, Suite 100
Victoria, TX 77904
(361)575-0611
Fax: (361)578-5500
Regular Hours: M-Fri 8am - 5pm
Every 3rd Thurs of the Month - Extended Hours Until 7 pm

Medical Disorders
Resources
Basic InformationLookupsLatest News
Survey Finds U.S. Parents Split on COVID Vaccination for Kids Under 12Most Unvaccinated Americans Want to Stay That Way: PollIt's Tick Season: Protect Yourself From Lyme DiseaseHigh-Tech Exoskeletons Improve Bowel Function in People With Spinal Cord Injury'Superbug' Fungus Spreads Among Vulnerable in Two U.S. CitiesVaccinations Start to Climb in States Hit Hard by Delta VariantAs Olympics Begin, Tokyo Posts Highest Number of New COVID Cases in Six MonthsVirtual Roller Coaster Ride Study Brings New Insights Into MigraineBiden Says Full Approval for COVID Vaccines Coming SoonPfizer Vaccine Offers 88% Protection Against Delta Variant, But 2 Doses NeededSecret Weapon: Why the 2nd Dose of Pfizer Vaccine Is So CrucialIn a First for the Continent, Pfizer COVID-19 Vaccine Will Be Produced in South AfricaLockdowns' Effects on Health Still Less Than Harm From Pandemic: ExpertsCOVID Drove Biggest Drop in U.S. Life Expectancy Since World War IIJ&J Vaccine Weak Against Delta Variant, 2nd Dose May Be NeededDouble Trouble: Wildfire Smoke Could Boost Odds for COVID's SpreadStatin Users May Have Added Protection Against Severe COVID-19Severe COVID in Kids: Rare, but Brain Issues Can ResultOne-Dose Blood Thinner Could Slash Blood Clot Risk After Knee ReplacementU.S. Issues Toughest Travel Alert for Britain As COVID Cases There ClimbPediatricians' Group: All School Kids, Staff Should Continue to Wear MasksGeneticists Probe Origins of Painful Cluster HeadachesAny COVID Infection Leaves Strong Antibody Levels in KidsMany Hit Hard by Pandemic Now Swamped by Medical DebtU.S. Surgeon General Backs Local Mask Mandates When NeededMake Summer Camp Safe for Your Child With Asthma, AllergiesCanada May Open Borders to Fully Vaccinated Americans by Mid-AugustCDC Advisors to Discuss 3rd COVID Vaccine Dose for ImmunocompromisedFDA to Prioritize Full Approval for Pfizer COVID VaccineEven a Little Lead in Drinking Water Can Harm People With Kidney DiseaseStatin's Health Benefits Far Outweigh  Any Potential Harms: StudyMore Than a Quarter of Long COVID Patients Still Not Recovered After 6 MonthsWhy Many Black & Hispanic Americans Distrust COVID VaccinesA Better Test to Help Spot Glaucoma?U.S. Surgeon General Issues Call to Counter 'Urgent Threat' of Vaccine MisinformationFriends, Family Key to Turning a 'No' on Vaccination to a 'Yes'AHA News: How Healthy Is Your Neighborhood? Where You Live Can Greatly Affect Heart, Brain HealthHeart Troubles Ease Over Time in Kids With MIS-CUltra-Processed Foods Might Help Drive Inflammatory Bowel DiseaseCOVID Antibodies From Vaccination Are Almost 3 Times Higher Than From InfectionHalf of U.S. Teens Plan to Get COVID Shot, But Can Numbers Go Higher?Many States Move to Ban Vaccine Mandates, Passports in Public SchoolsBusted Ankle? What's Better, a Cast or Brace?New COVID Cases Double in U.S. in Past Three WeeksAmericans With Diabetes Were Hit Hard by COVID PandemicAHA News: The Challenge of Diabetes in the Black Community Needs Comprehensive SolutionsInhaled COVID Vaccine Shows Promise in Animal TrialsFlu Shot Might Help Ward Off Severe COVIDCould Men's Testosterone Play Role in COVID Survival?Adults With ADHD May Face Higher Odds for Physical Illnesses: Study
Questions and AnswersLinks
Related Topics

Diabetes

Many 'High Priority' Patients Aren't Getting Put on Kidney Transplant Lists

HealthDay News
by By Amy Norton HealthDay Reporter
Updated: Jun 18th 2021

new article illustration

FRIDAY, June 18, 2021 (HealthDay News) -- Many Americans who stand to benefit most from a kidney transplant may be missing a key window of opportunity, a new study finds.

The study focused on kidney failure patients who would be expected to live many years after receiving a kidney transplant. That generally includes relatively younger people without other major medical conditions.

In 2014, the U.S. kidney allocation system made changes to help ensure those patients receive a donor kidney that is likely to function for many years — which typically means from a young, healthy donor.

A scoring system, called the estimated post-transplant survival (EPTS) score, was introduced. Once transplant candidates are placed on the waitlist, they are given an EPTS score; those in the "top 20%" get priority whenever a particularly high-quality kidney becomes available.

But the new study found that many patients who would fall into that category are not making it onto the transplant waitlist in a timely manner.

Of more than 42,000 U.S. patients who would score in the top 20%, fewer than half were on the waitlist. And among the 34,000-plus who'd started kidney dialysis, only 37% were waitlisted for a transplant within three years.

"It's extremely discouraging," said study leader Jesse Schold, a researcher at the Cleveland Clinic in Ohio.

These are patients who are very likely to do well after a transplant, he said. But by the time they get on the transplant list, many will no longer have a top EPTS score.

In fact, Schold's team found, of dialysis patients, 61% fell out of the top 20% group within 30 months. And, as seen throughout U.S. health care, there were disparities: Black patients and those from low-income groups were less likely to be waitlisted.

The findings were published online June 17 in the Journal of the American Society of Nephrology.

Kidney transplant is considered the best option for most people with end-stage kidney disease, or kidney failure. Currently, more than 90,000 Americans are on the donor-kidney waitlist, according to the United Network for Organ Sharing (UNOS), the nonprofit that manages the nation's donor organ system.

"It's much better to be referred for a transplant before you need dialysis, which is called preemptive waitlisting," said Dr. Joseph Vassalotti, chief medical officer of the nonprofit National Kidney Foundation. "Unfortunately, that doesn't happen enough."

The current study, he noted, looked at patients who would be optimal transplant candidates — all with EPTS scores in the top 20% and an average age of 38.

"They should have a very high percentage of placement on the waitlist," Vassalotti said.

Yet of the 42,445 patients, only about 7,900 were preemptively waitlisted. The rest — more than 34,500 — started dialysis sometime between 2015 and 2017, and only 37% moved onto the transplant waitlist within three years.

Ideally, the issue needs to be addressed far "upstream," Schold said — meaning more Americans with kidney disease need access to optimal care well before their kidneys fail.

Vassalotti said racial and income disparities in waitlisting might, at least in part, be related to lack of access to specialized kidney (nephrology) care — whether it's because primary care doctors are not referring patients, patients cannot afford it, or there are few specialists in patients' local areas.

But Vassalotti also said doctors need to do a better job of communicating about the benefits and risks of transplant versus dialysis. And those discussions, he said, should happen early, so patients can be "empowered" to plan for what they want when their disease progresses.

Darren Stewart, principal research scientist with UNOS, said the EPTS score has helped better "longevity match" transplant candidates with donor kidneys. (Donor kidneys, themselves, are also subject to a scoring system.)

"But this study highlights the disparities in access to the waitlist in the first place," Stewart said.

He noted that UNOS does not have the ability to create policies on what happens before patients are waitlisted. But he agreed that both better access to nephrology care, and better patient education about transplants, are needed.

Schold also said that education is critical, but the process of getting on the waitlist could be made less cumbersome, too.

He pointed to the idea of an automated system that refers all patients with late-stage kidney disease for a transplant — or at least a subset of patients, such as those who would have a top 20% EPTS score.

"We have to make these processes easier," Schold said.

More information

The National Kidney Foundation has more on kidney transplantation.

SOURCES: Jesse Schold, PhD, researcher, quantitative health sciences, Cleveland Clinic, Ohio; Darren Stewart, MS, principal research scientist, United Network for Organ Sharing, Richmond, Va.; Joseph Vassalotti, MD, chief medical officer, National Kidney Foundation, New York City; Journal of the American Society of Nephrology, June 17, 2021, online