TY - JOUR
T1 - The Perspectives of General Nephrologists Toward Transitions of Care and Management of Failing Kidney Transplants
AU - Alhamad, Tarek
AU - Murad, Haris
AU - Dadhania, Darshana M.
AU - Pavlakis, Martha
AU - Parajuli, Sandesh
AU - Concepcion, Beatrice P.
AU - Singh, Neeraj
AU - Murakami, Naoka
AU - Casey, Michael J.
AU - Ji, Mengmeng
AU - Lubetzky, Michelle
AU - Tantisattamo, Ekamol
AU - Alomar, Omar
AU - Faravardeh, Arman
AU - Blosser, Christopher D.
AU - Basu, Arpita
AU - Gupta, Gaurav
AU - Adler, Joel T.
AU - Adey, Deborah
AU - Woodside, Kenneth J.
AU - Ong, Song C.
AU - Parsons, Ronald F.
AU - Lentine, Krista L.
N1 - Funding Information:
The authors would like to acknowledge Daniel Coyne, MD, Tingting Li, MD, and Anitha Vijayan, MD at Washington University in St. Louis for the review of the survey. We also thank the survey respondents for sharing their valuable time and perspectives in completing the survey, and members of the AST Education Committee for their review and feedback.
Publisher Copyright:
Copyright © 2023 Alhamad, Murad, Dadhania, Pavlakis, Parajuli, Concepcion, Singh, Murakami, Casey, Ji, Lubetzky, Tantisattamo, Alomar, Faravardeh, Blosser, Basu, Gupta, Adler, Adey, Woodside, Ong, Parsons and Lentine.
PY - 2023
Y1 - 2023
N2 - The management of failing kidney allograft and transition of care to general nephrologists (GN) remain a complex process. The Kidney Pancreas Community of Practice (KPCOP) Failing Allograft Workgroup designed and distributed a survey to GN between May and September 2021. Participants were invited via mail and email invitations. There were 103 respondents with primarily adult nephrology practices, of whom 41% had an academic affiliation. More than 60% reported listing for a second kidney as the most important concern in caring for patients with a failing allograft, followed by immunosuppression management (46%) and risk of mortality (38%), while resistant anemia was considered less of a concern. For the initial approach to immunosuppression reduction, 60% stop antimetabolites first, and 26% defer to the transplant nephrologist. Communicating with transplant centers about immunosuppression cessation was reported to occur always by 60%, and sometimes by 29%, while 12% reported making the decision independently. Nephrologists with academic appointments communicate with transplant providers more than private nephrologists (74% vs. 49%, p = 0.015). There are heterogeneous approaches to the care of patients with a failing allograft. Efforts to strengthen transitions of care and to develop practical practice guidelines are needed to improve the outcomes of this vulnerable population.
AB - The management of failing kidney allograft and transition of care to general nephrologists (GN) remain a complex process. The Kidney Pancreas Community of Practice (KPCOP) Failing Allograft Workgroup designed and distributed a survey to GN between May and September 2021. Participants were invited via mail and email invitations. There were 103 respondents with primarily adult nephrology practices, of whom 41% had an academic affiliation. More than 60% reported listing for a second kidney as the most important concern in caring for patients with a failing allograft, followed by immunosuppression management (46%) and risk of mortality (38%), while resistant anemia was considered less of a concern. For the initial approach to immunosuppression reduction, 60% stop antimetabolites first, and 26% defer to the transplant nephrologist. Communicating with transplant centers about immunosuppression cessation was reported to occur always by 60%, and sometimes by 29%, while 12% reported making the decision independently. Nephrologists with academic appointments communicate with transplant providers more than private nephrologists (74% vs. 49%, p = 0.015). There are heterogeneous approaches to the care of patients with a failing allograft. Efforts to strengthen transitions of care and to develop practical practice guidelines are needed to improve the outcomes of this vulnerable population.
KW - failing kidney allograft
KW - immunosuppression management
KW - multidisciplinary team
KW - re-transplantation
KW - transition of care
UR - http://www.scopus.com/inward/record.url?scp=85164854130&partnerID=8YFLogxK
U2 - 10.3389/ti.2023.11172
DO - 10.3389/ti.2023.11172
M3 - Article
C2 - 37456682
AN - SCOPUS:85164854130
SN - 0934-0874
VL - 36
JO - Transplant International
JF - Transplant International
M1 - 11172
ER -