WAITLISTING DYNAMICS FOR KIDNEY TRANSPLANTATION IN AOTEAROA NEW ZEALAND: SUSPENSIONS, TRANSPLANTATION AND DEATHS
Nicole De La Mata1, Nicholas Cross2, Heather Dunckley3, Ben Beaglehole4, John Irvine2, Curtis Walker5, Ian Dittmer6, Merryn Jones7, Patrick Kelly1, Kate Wyburn8,9, Angela Webster1,10,11, 1Sydney School of Public Health, Faculty of Medicine and Health, TheUniversity Of Sydney, Camperdown, NSW, Australia2Department of Nephrology, Te Whatu Ora – Waitaha Canterbury, Christchurch Hospital, Christchurch, New Zealand3New Zealand Transplantation and Immunogenetics Laboratory, New Zealand Blood Service, Auckland, New Zealand4Department of Psychological Medicine, University of Otago, Christchurch, New Zealand5Internal Medicine, Medical Council of New Zealand, Te Whatu Ora Te Pae Hauora o Ruahine o Tararua MidCentral, New Zealand6Auckland City Hospital, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand7Kidney Health New Zealand Tākihi Hauora Aotearoa, Christchurch, New Zealand8Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia9Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia10Centre for Renal and Transplant Research, Westmead Hospital, Westmead, NSW, Australia11NHMRC Clinical Trials Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
Abstract
Aim:We sought to describe the journey of patients waitlisted for their first kidney transplantation in Aotearoa New Zealand (NZ), including suspensions, return to waitlist, transplantation, and death.
Background:Being on the kidney transplant waitlist is not always a straightforward process. Patients may be suspended and return to the waitlist, once or several times. Few studies have described individual patient transitions on and off the waiting list, with no studies in Aotearoa NZ.
Methods:We included all incident patients waitlisted for their first transplant in Aotearoa NZ, during 2005-19, using the ASSET linked data platform. We summarised all transitions after first waitlist entry, including transplantation, suspension, and death. We estimated the median time to these transitions and the annual probability of being in each state over 5 years.
Results:Of 2,631 patients entering Aotearoa NZ kidney transplant waitlist, 1,457(55%) were transplanted, 270(10%) were still waiting, 334(13%) were suspended and 570(22%) died while waiting. 1,542(59%) were suspended at least once, of which most (51%) spent <6 months suspended per episode. Median time from waitlist entry to transplant increased with more suspensions, from 1.0 year(IQR:0.4-1.9) for those never suspended to 4.2 years(IQR:3.0-5.7) for those suspended ≥2 times. At 1-year, the probability of transplant was 27%(95%CI:25-29%), active on waitlist was 74%(95%CI:72-76%), suspended was 24%(95%CI:22-26%) and death was 2%(95%CI:2-3%). The probability of transplant at 5-years was 60%(95CI:58-62%), active on waitlist was 8%(95%CI:7-9%), suspended was 16%(95%CI:15-18%) and 16%(95%CI:14-17%) died.
Conclusion:Nearly two-thirds of people waitlisted for kidney transplant in Aotearoa NZ will be suspended at least once, resulting in much longer time until transplant. Further research should explore whether patient or clinical factors are associated with disparities in being suspended and returning to waitlist.
Biography
Dr Nicole De La Mata, BSc (Biology), MBiostats, PhD (epidemiology/biostatistics) is an early-mid-career biostatistician researcher and senior lecturer in biostatistics at the University of Sydney. Her expertise lies in establishing data linkage studies and using these to apply advanced statistical models to understand patient journeys and complex clinical scenarios. Her work has broadly aimed to improve health service quality and efficiency to translate into better and more equitable patient outcomes.