Abstract
Introduction: Being on the kidney transplant waitlist is not always a straightforward process. Patients may be suspended and return to the waitlist, once or several times. Few studies have described individual patient transitions on and off the waiting list, with no studies in Aotearoa NZ. We sought to describe the journey of patients waitlisted for their first kidney transplantation in Aotearoa New Zealand (NZ), including suspensions, return to waitlist, transplantation, and death.
Methods: We included all incident patients waitlisted for their first transplant in Aotearoa NZ, during 2005-19, using the ASSET linked data platform. We summarised all transitions after first waitlist entry, including transplantation, suspension, and death. We estimated the median time to these transitions and the annual probability of being in each state over 5 years.
Results: Of 2,522 patients entering Aotearoa NZ kidney transplant waitlist, 1,418(56%) were transplanted, 233(9%) were still waiting, 298(12%) were suspended and 573(23%) died while waiting. 1,497(59%) were suspended at least once, of which 29% spent <3 months suspended per episode and 38% spent more than 1 year per episode. Median time from waitlist entry to transplant increased with more suspensions, from 1.0 year (IQR:0.4, 1.9) for those never suspended to 3.4 years (IQR:1.9, 4.9) for those ever suspended. At 1-year, the probability was transplant was 20% (95%CI: 19-22%), active on waitlist was 58% (95%CI:56-60%), suspended was 19% (95%CI: 18-21%) and death was 2% (95%CI: 1-2%). The probability of transplant at 5-years was 55% (95CI%:53-57%), active on waitlist was 9% (95%CI:8-11%), suspended was 20% (95%CI:18-21%) and death was 16% (95%CI:15-18%).
Conclusion: Nearly two-thirds of people waitlisted for kidney transplant in Aotearoa NZ will be suspended at least once, resulting in much longer time until transplant. Further research should explore whether patient or clinical factors are associated with disparities in being suspended and returning to waitlist.
Poster presentation.