The Perspectives of General Nephrologists Toward Transitions of Care and Management of Failing Kidney Transplants

• Type of Material: Article
• Authors: Tarek Alhamad, Washington University; Haris Murad, Washington University; Darshana M Dadhania, Weill Cornel Medicine - New York Presbyterian Hospital; Martha Pavlakis, Harvard University; Sandesh Parajuli, University of Wisconsin; Beatrice P Concepcion, University of Chicago; Neeraj Singh, Willis Knighton Health System, Shreveport; Naoka Murakami, Harvard Medical School; Michael J Casey, University of South Carolina; Mengmeng Ji, Washington University; Michelle Lubetzky, University of Texas Austin; Ekamol Tantisattamo, University of California, Irvine; Omar Alomar, Washington University; Arman Faravardeh, SHARP Kidney and Pancreas Transplant Center, San Diego; Christopher D Blosser, University of Washington; Arpita Basu, Emory University; Gaurav Gupta, Virginia Commonwealth University; Joel T Adler, University of Texas Austin; Deborah Adey, University of California San Francisco; Kenneth J Woodside, University of Michigan; Song C Ong, University of Alabama; Ronald F Parsons, Emory University; Krista L Lentine, Saint Louis University
• Language: English
• Date: 2023-06-30
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 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.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/ti.2023.11172
• Title of Journal or Parent Work: TRANSPLANT INTERNATIONAL
• Volume: 36
• Start Page: 11172
• End Page: 11172
• Keywords: HEMODIALYSIS; Life Sciences & Biomedicine; RENAL-ALLOGRAFT FAILURE; immunosuppression management; transition of care; multidisciplinary team; Science & Technology; failing kidney allograft; DIALYSIS; Transplantation; MORTALITY; re-transplantation; Surgery
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.