Waiting time on dialysis for active access to renal transplantation: a multicenter cross-sectional study in Lombardy

Abstract

Background: The amount of time spent in dialysis waiting for a renal transplantation significantly affects its outcome. Hence, the timely planning of patients’ transplant evaluation is crucial. According to data from the Nord Italia Transplant program (NITp), the average waiting time between the beginning of dialysis and the admission to the regional transplant waiting list in Lombardy is 20.2 months.

Methods: A multicenter cross-sectional study was conducted in order to identify the causes of these delays and find solutions. Two questionnaires were administered to the directors of 47 Nephrology Units and to 106 patients undergoing dialysis in Lombardy respectively, during their first visit for admission to the transplant waiting list.

Results: The comparative analysis of the results revealed that both patients (52%) and directors (75%) consider the time required for registering to the waiting list too long. Patients judge information about the transplant to be insufficient, especially regarding the pre-emptive option (63% of patients declare that they had not been informed about this opportunity). Patients report a significantly longer time for the completion of pre-transplantation tests (more than 1 year in 23% of the cases) compared to that indicated by the directors.

Conclusions: The study confirmed the necessity of providing better and more timely information to patients regarding the different kidney transplantation options and highlighted the importance of creating target-oriented and dedicated pathways in all hospitals.

 

Keywords: Renal transplantation, waiting list, active access to renal transplantation, questionnaire, Lombardy region

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Introduzione

Esiste un generale consenso sul fatto che il trapianto renale rappresenti, per i candidati idonei, la scelta migliore in termini di qualità di vita [13] e di sopravvivenza [45]. Il trapianto rappresenta un vantaggio anche in termini economici, in quanto i costi della dialisi sono superiori a quelli del follow-up dei pazienti portatori di trapianto [67]. Il tempo di attesa in dialisi influisce significativamente sia sui risultati del trapianto sia sullo sviluppo di comorbidità [811]. Data la scarsa disponibilità di organi da donatore deceduto, il trapianto da vivente è un’opzione valida. [12]. 

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