Factors Associated with Waiting time to Deceased Donor Kidney Transplantation in Transplant Recipients

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BackgroundDespite the benefits of kidney transplantation, numerous end-stage renal disease patients have still not received renal replacement therapy. Along that renal donor allocation system has been developed and enormous transplant demand increases, appropriate management or preparation for waitlisted patients is necessary. The purpose of this study was to analyze the status of waitlisted decease donor kidney transplant candidates in transplant recipients according to waiting time and associated factors.MethodPatients who were on the waiting list for deceased donor kidney transplantation and already received transplantation at the Seoul National University Hospital from 2000 to 2017 were included in this study. We retrospectively reviewed the medical records and clinical data from the KONOS for these patients. Student t-test and Chi-square test were used for statistical analysis.ResultTotal 606 patients received decease donor kidney transplantation and 364 (60.1%) were males. The mean age of the donors was 43.8 years. The average transplant waiting time was 45 months (44 months in the 1st transplant group vs. 47months in the re-transplant group. Among them, 534 (88.1%) were the primary transplantation and 72 (11.9%) were the re-transplantation. In bloody type analysis, 216 (35.6%) were type A, 170 (28.1%) were B, 135 (22.3%) were O and 85 (14%) were AB. Among the 534 primary transplant patients, 241 (45.2%) were positive for PRA, 59 (11%) were negative, and 234 (43.8%) were unknown. Among the 72 re-transplant recipients, 25 (34%) were positive for PRA, 13 (18.1%) were negative, and 34 (47.9%) were unknown.The mean waiting time was 45 months in the primary transplant recipients and 47 months in re-transplant recipients. In the observation of waiting time according to blood type, type A and B had 45 months, type O was 39 months, and type AB was 32 months. In the analysis of an effect of ages on waiting time, the waiting time for both primary and re-transplantation was the shortest in 0~20 years (16 and 31 months, respectively). The waiting time was the longest in 31~40 year-aged recipients to have re-transplantation. This can be due to the effect of the added point on the children. The waiting time for PRA-positive primary and re-transplantation recipients was 63 months and 66 months, respectively. The time for PRA-negative re-transplant recipients was each 51 and 41 months.ConclusionThis study showed that blood type AB and high PRA were the most important determining factors associated with long waiting time in renal transplant recipients regardless of primary or re-transplantation. Therefore, it is necessary to establish a management strategy such as close and frequent monitoring PRA changes and tailored desensitization for highly-sensitized patients on waiting list.

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