Patient Preferences for Choices in Kidney Transplant Examined

Patients are willing to receive a worse-quality kidney sooner in order to avoid additional waiting time for transplant, according to a study published online Aug. 19 in the Clinical Journal of the American Society of Nephrology.

Sanjay Mehrota, Ph.D., from Northwestern University in Evanston, Illinois, and colleagues used a discrete-choice experiment that presented a deceased donor kidney to 605 patients who are waiting for or have received a kidney transplant. The choice involved a tradeoff between accepting a kidney now or in the future; the options were designed to quantify the relative importance of kidney quality and waiting time.

The researchers found that the average respondent would accept a kidney today with 6.5 years of expected graft survival in order to avoid an additional two years of waiting for a kidney with 11 years of expected graft survival. Three classes of patient preference were identified: class 1 was averse to extra waiting time but responsive to improvements in kidney quality; class 2 was less willing to accept a longer waiting time for improvements in the quality of the kidney; and class 3 was willing to accept a longer waiting time even for a small improvement in the quality of the kidney. Respondents in class 3 versus class 1 were more likely to be age 61 years or younger and waitlisted before initiating dialysis.

“The findings suggest many patients, particularly older patients and patients with lower performance status, would consider high Kidney Donor Profile Index kidneys in order to receive a kidney transplant sooner,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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