Variation in Structure and Delivery of Care Between Kidney Transplant Centers in the United States

Abstract

Although the United States possesses one of the most comprehensive transplant registries in the world, nationally representative data on how transplant care is structured and delivered is lacking. Therefore, we surveyed all 208 adult kidney transplant centers in the United States, excluding 37 pediatric and 58 inactive adult centers. Respondents were asked about the characteristics of their kidney transplant programs (25 items), the structure and process of care (18 items), coordination of care (10 items) and the characteristics of transplant physicians and surgeons (9 items). The survey was completed by directors of 156 transplant centers (75% response). The results demonstrated significant variation between centers in several domains. Sixty-five percent of transplant centers do not have a dedicated transplant pharmacist in outpatient care. Two-thirds of transplant centers do not see the kidney transplant recipients at least monthly during the first year. Less than 30% of centers perform either joint sit-down or walking rounds between nephrology and transplant surgery. There was significant variation in the structure and process of care in kidney transplantation. This implies variation in the use of resources at the transplant centers. This variation should be studied to determine best practices associated with optimal kidney allograft and patient survival.

A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs

“…Results demonstrated a mean number of 4.25 FTEs per 325 transplant performed, or 1.3 pharmacist FTEs per 100 transplants, which is similar to the results from this survey. Israni et al published a recent analysis demonstrating that the availability of a transplant pharmacist during both inpatient and outpatient care was only present at 35% of centers, with nearly 4 in 10 respondents stating that there was no identified dedicated transplant pharmacist associated with their program (18). This is significantly lower than what is reported in the results within our survey, which may be due to using the term ''dedicated'' in the Israni question or the fact that our results were skewed towards larger programs.…”

Towards Improving the Transfer of Care of Kidney Transplant Recipients

“…The 2000 American Society of Transplantation recommendations for outpatient surveillance of kidney transplant recipient suggest routine posttransplant visits 2–3 times per week during the first posttransplant month, every 1–3 weeks between 1 and 3 months posttransplantation, every 4–8 weeks between months 4 and 12 posttransplantation, and every 2–4 months thereafter . U.S. transplant centers seem to be following these recommendations . The 2009 Kidney Disease Improving Global Outcomes guidelines did not recommend a frequency of outpatient follow‐up .…”

Development and validation of PART (Pharmacotherapy Assessment in Renal Transplant Patients) criteria to assess drug‐related problems in an outpatient renal transplant population: A cross‐sectional study

“…3 After the early post-transplant period, patients are regularly returned to their referring center and may have limited access to expert transplant pharmacists who would rapidly intervene when problems occur with the medication regimen. 4 This is particularly relevant as transplant patients are at risk for serious adverse events such as graft rejection, opportunistic infections, hospitalization, and drug toxicity due to errors in their pharmacotherapy. 3 Furthermore, low adherence remains problematic in many cases, as 20% to 70% of kidney transplant recipients (KTR) are not totally adherent to their immunosuppressant therapy, increasing the risk of rejection.…”