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 - 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 -