학술논문
The Perspectives of General Nephrologists Toward Transitions of Care and Management of Failing Kidney Transplants
Document Type
article
Author
Alhamad, Tarek; Murad, Haris; Dadhania, Darshana M; Pavlakis, Martha; Parajuli, Sandesh; Concepcion, Beatrice P; Singh, Neeraj; Murakami, Naoka; Casey, Michael J; Ji, Mengmeng; Lubetzky, Michelle; Tantisattamo, Ekamol; Alomar, Omar; Faravardeh, Arman; Blosser, Christopher D; Basu, Arpita; Gupta, Gaurav; Adler, Joel T; Adey, Deborah; Woodside, Kenneth J; Ong, Song C; Parsons, Ronald F; Lentine, Krista L
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Subject
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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.