A study by Mayo Clinic and the University of Michigan shows that only one-third of patients who ultimately receive a living donor kidney transplant receive it pre-emptively, before starting dialysis.
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Less than two-thirds receive a transplant either pre-emptively or within a year of starting dialysis.
Existing research suggests that less time spent on dialysis before transplant can improve patient outcomes and survival after transplant.
However, this new research shows there has been no increase in the utilization of what is known as timely living donor kidney transplants, which includes pre-emptive and early transplants, since 2006.
The study "Under-utilization of timely kidney transplants in those with living donors," was published recently in the American Journal of Transplantation.
Mayo Clinic and University of Michigan researchers examined data from the United Network for Organ Sharing to evaluate the use of timely kidney transplants from 2000 to 2012 for 68,128 patients who received living donor transplants.
Although data showed an improvement in the use of pre-emptive and early living donor transplants between 2000 and 2006, there has been no improvement since.
Factors that influence a person's chance of receiving a timely living kidney transplant are thought to include lack of available living donors, decreased number of living donors, lack of insurance, lack of education or knowledge, delayed diagnosis and delayed referral.
Paired donations and direct donation represent two viable and available options for timely living kidney transplant. Yet both can be influenced by early referral and by a patient's understanding of their situation and the transplant evaluation process.
The use of timely kidney transplant can vary greatly from one transplant center to another, based on factors including the patient population, the transplant team and its comfort in evaluating living donors, and providing prompt transplant evaluations for patients.
But approximately 80 percent of kidney transplants at Mayo Clinic in the past 15 years have been from living donors, with 40 percent of those being pre-emptive living donor transplants. ■