Novel Kidney Transplant Evaluation Program Linked to Greater Odds of Waitlisting

New research is shedding light on the potential utility of a comprehensive, patient-centered, system-level fast-track kidney transplant evaluation process for patients with end-stage kidney disease (ESKD) seeking to be waitlisted for transplantation.1

The nonrandomized clinical trial compared a prospective cohort of patients who received the Kidney Transplant Fast Track (KTFT) intervention at the University of Pittsburgh Medical Center Starzl Transplantation Institute with a historical control sample of patients who received standard care prior to implementation of KTFT. Results showed KTFT was associated with a greater likelihood of waitlisting and transplantation with fewer disparities by race and ethnicity than standard care.1

The KTFT intervention involves completing most or all testing on the day of patients’ first pretransplant clinic appointment. The intervention consisted of 4 phases, including actions before the evaluation clinic appointment; actions during the evaluation clinic appointment; actions during evaluation clinic discharge; and actions after the evaluation clinic appointment.1

“In contrast to more elaborate, multifaceted support interventions, the KTFT intervention represents a more simple approach directly aimed at logistical barriers to completing kidney transplant evaluations in a timely, efficient fashion,” Raegan Durant, MD, MPH, a professor in the division of preventive medicine at the University of Alabama at Birmingham School of Medicine, wrote in an editor’s note.2

To investigate the association between KTFT evaluation and the likelihood of waitlisting, transplantation, and associated disparities compared with standard care, Larissa Myaskovsky, PhD, a professor in the department of internal medicineand director of the Center for Healthcare Equity in Kidney Disease at the University of New Mexico, and colleagues conducted a prospective comparative cohort trial with a historical control comparison.1

KTFT was implemented for all patients undergoing kidney transplantation at the University of Pittsburgh Medical Center Starzl Transplantation Institute in 2012. The present study included patients who were scheduled for transplant evaluation between May 2015 and June 2018 and followed up via electronic health record (EHR) through August 2022. The historical control sample was obtained from a patient cohort scheduled for transplant evaluation at the same center between March 2010 and October 2012 and followed up via EHR through August 2018.1

For inclusion in both study samples, patients were required to be scheduled for a kidney transplant appointment, ≥ 18 years of age, without a prior kidney transplant, not waitlisted for kidney transplant, and speak English.1

The main outcome variables were time to transplant waitlisting and, among waitlisted patients, time to kidney transplant.1

In total, the study included 1118 participants who received KTFT and 1152 participants who received standard care. In the KTFT group, the mean age was 57.2 years, 37.2% of patients were female, and the majority were non-Hispanic White (70.7%). In the historical control group, the mean age was 55.5 years, 38.8% of patients were female, and the majority were non-Hispanic White (68.5%).1

After adjusting for demographic and clinical factors, patients in the KTFT group were more likely to be placed on the active waitlist for kidney transplantation over a 7-year follow-up period than those in the historical control group (subdistribution hazard ratio [SHR], 1.40; 95% CI, 1.24-1.59). Among those who were waitlisted, investigators noted patients in the KTFT group were more likely to receive a transplant (SHR, 1.21; 95% CI, 1.04-1.41).1

Further analysis revealed that among patients in the KTFT group, Black patients (SHR, 1.54; 95% CI, 1.11-2.14) and White patients (SHR, 1.38; 95% CI, 1.16-1.65) were more likely to be waitlisted than those in the historical control group. While investigators found no significant differences in likelihood of waitlisting between Black and White patients in the KTFT group (SHR, 0.79; 95% CI, 0.61-1.01) or between patients with other race or ethnicity and White patients in the KTFT group (SHR, 0.77; 95% CI, 0.51-1.15), they noted Black patients were significantly less likely to be waitlisted than White patients in the historical control group (SHR, 0.71; 95% CI, 0.58-0.87).1

Additionally, Black patients in the KTFT group were more likely to receive a transplant after waitlisting than Black patients in the historical control group (SHR, 1.52; 95% CI, 1.06-2.16).1

“We believe that KTFT should be implemented as standard care across transplant centers to the greatest extent possible,” investigators concluded.1 “We hope that clinicians at various health care systems can use the results of our work to make a case for implementing a similar approach in their respective transplant centers.”

References

1. Myaskovsky L, Leyva Y, Puttarajappa C, et al. Kidney Transplant Fast Track and Likelihood of Waitlisting and Transplant: A Nonrandomized Clinical Trial. JAMA Intern Med. doi:10.1001/jamainternmed.2025.0043

2. Durant RW. Kidney Transplant Evaluations—Why Put Off Until Tomorrow What You Can Do Today? JAMA Intern Med. doi:10.1001/jamainternmed.2025.0084