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A Survey of Nephrologists’ Views on Preemptive Transplantation

Françoise G. Pradel^*, Rahul Jain^*, C. Daniel Mullins^*, Joseph A. Vassalotti, and Stephen T. Bartlett

^* Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland; National Kidney Foundation and Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, New York; and Department of Surgery, School of Medicine, University of Maryland, Baltimore, Maryland

Correspondence: Françoise G. Pradel, University of Maryland School of Pharmacy, Department of Pharmaceutical Health Services Research, 220 Arch Street, Office Level One, Baltimore, MD 21201. Phone: 410-706-4044; Fax: 410-709-5394; E-mail: fpradel{at}rx.umaryland.edu

Background and objectives: Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists’ views on preemptive transplantation are explored herein.

Design, setting, participants, & measurements: A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation.

Results: Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients’ education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%).

Conclusions: Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.