Evidence map›Paper›PMID 38017628›Full record

ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2024

Journey to kidney transplantation: patient dynamics, suspensions, transplantation and deaths in the Australian kidney transplant waitlist.

Nicole L De La Mata, Victor Khou, James A Hedley, Patrick J Kelly, Rachael L Morton, Kate Wyburn, Angela C Webster

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Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Nicole L De La MataSydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0001-7739-3656
Victor KhouSydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0002-1890-6092
James A HedleySydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0002-6077-0862
Patrick J KellySydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0002-5015-0977
Rachael L MortonNHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0001-7834-0572
Kate WyburnSydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0002-5288-7200
Angela C WebsterSydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.ORCID 0000-0001-7509-0512

Funding

National Health and Medical Research Council APP1171364
6 · The paper itself

Abstract

backgroundPeople on the kidney waitlist are less informed about potential suspensions. Disparities may exist among those who are suspended and who return to the waitlist. We evaluated the patient journey after entering the waitlist, including suspensions and outcomes, and factors associated with these transitions.

methodsWe included all incident patients waitlisted for their first transplant from deceased donors in Australia from 2006 to 2019. We described all clinical transitions after entering the waitlist. We predicted the restricted mean survival time (unadjusted and adjusted) until first transplant by the number of prior suspensions. We evaluated factors associated with transitions using flexible survival models and clinical endpoints using Cox models.

resultsOf 8466 patients waitlisted and followed over 45 757.4 person-years (median 4.8 years), 6741 (80%) were transplanted, 381 (5%) died waiting and 1344 (16%) were still waiting. A total of 3127 (37%) people were suspended at least once. Predicted mean time from waitlist to transplant was 3.0 years [95% confidence interval (CI) 2.8-3.2] when suspended versus 1.9 years (95% CI 1.8-1.9) when never suspended. Prior suspension increased the likelihood of further suspensions 4.2-fold (95% CI 3.8-4.6) and returning to the waitlist by 50% (95% CI 36-65) but decreased the likelihood of transplantation by 29% (95% CI 62-82). Death risk while waiting was increased 12-fold (95% CI 8.0-18.3) when currently suspended. Australian non-Indigenous males were 13% [hazard ratio (HR) 1.13 (95% CI 1.04-1.23)] and Asian males 23% [HR 1.23 (95% CI 1.06-1.42)] more likely to return to the waitlist compared with females of the same ethnicity.

conclusionThe waitlist journey was not straightforward. Suspension was common, impacted the chance of transplantation and meant waiting an average of 1 year longer until transplant. We have provided estimates for and factors associated with suspension, relisting and outcomes after waitlisting to support more informed discussions. This evidence is critical to further understand drivers of inequitable access to transplantation.

Indexed as

Kidney TransplantationWaiting ListsAdultAgedAustraliaFemaleHumansKidney Failure, ChronicMaleMiddle AgedSurvival RateTissue and Organ ProcurementAustraliakidney waitlistoutcomesrelistingsuspension

Identifiers

PMID38017628
PMCPMC11210985

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.